Independent study requested for____________________________semester, year___________________________

Course number and title_________________________________________________________________________

Is this course required for graduation? ___________yes ___________no

Why is independent study requested?________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________

Describe the proposed project or attach abstract_______________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________

Instructions to the instructor:
Please attach the course syllabus which will serve as the contract with the student.

Please specify how often the student will meet with the instructor.____________________________________________
_____________________________________________________________________________________________

To be completed by the department chair: (check one)
    The full-time instructor will receive no compensation for teaching the independent study section of the course.
    The associate faculty instructor will receive no compensation for teaching the independent study section of the course.
    Compensation is to be provided. The contract is attached.
      (REQUIRES DEAN'S SIGNATURE)

Student:_________________________________________________ Date:____________________________

Insturctor:________________________________________________ Date:____________________________

Advisor:_________________________________________________ Date:____________________________

Chair:___________________________________________________ Date:____________________________

Dean:___________________________________________________ Date:____________________________

Distribution: Student file; Departmental faculty file

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