When students have late work, it disrupts the learning environment and provides a barrier for teachers who are trying to assess students' knowledge and skills. At the secondary level, it is especially important for students to take ownership of their education and advocate for their future success. This form sets reasonable expectations and encourages students to be more responsible by requiring them to indicate the reason(s) for their late work and to write a statement that includes a plan.
I am currently using this form with 8th, 9th, and 10th grade students; however, it could fit a variety of grade levels. It is intended primarily for formative assessments but includes language that could apply to summative assessments.