Extensions can be requested 10 days prior to original due date, no sooner.
Please select the program(s) for which you have not passed assessment:
Please choose one of the following:
I no longer wish to complete the assessment for the program.
I need a 30 day extension to complete the assessment.
Group Fitness Directors Name
Group Fitness Directors Email Address
Reason for needing an extension:
Check this box if you would no longer like to receive email communications from MOSSA.
By submitting this form, you agree to the
Terms and Conditions