Original form obtained through faculty advisor’s department office

1. Status: Graduate Student ___ Undergraduate Student ___
2. Proposed semester: Year ___ Fall ___ Spring ___ Sum I ___ Sum II ___
   1. Students, together with the faculty member supervising Indipendent Study, must have this approval form processed through the steps listed in section E prior to the end of the late registration process.
3. Student Information
   1. Social Security number:
   2. Student name:
   3. Student’s mailing address:
4. Rationale and Plan of Study (sample proposal): In conjunction with a faculty member, prepare an independent study proposal to be attached to this form. The proposal must include:
   1. a rationale for conducting an independent study
   2. the purpose of the study
   3. objectives
   4. activities to accomplish objectives
   5. required reading and/or a bibliography
   6. an evalution process*
   7. use for special purpose, i.e., liberal studies elective, writing intensive, Honors College, non-western, etc.
   8. number of credits** 
5. Signature Approvals and Verification:
   1. Faculty Member of Record: (This is the faculty member with whom you will be doing your independent study and who will be grading you.)
   2. Faculty Advisor:
   3. Chairperson: (of the department of the faculty member you will be working with)
   4. College Dean: (again, of your faculty member’s college)
   5. Registrar:

* It is a good idea to give yourself many opportunities to be evaluated rather than stake your whole grade on a single paper or project.

** No student may take more than six credits of Independent Study.