Name of Student: _______________________________________________________________________
Major/Minor_______________________________________ Class in College _______ GPA _________
Faculty Sponsor _________________________________________________________________________
Semester/Year for Study __________________________________________________________________
Course Number and Title __________________________________________________________________
Credits _____________________________
Topic of Independent Study:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Requirements for Independent Study (Please
attach detailed description of
activities:
goal of study,
meeting times, written assignments, special topics,
reading list, other
relevant details).
Approved: Signature Date
Student ________________________________________________________ ___________
Faculty Sponsor ________________________________________________________ ___________
Faculty Advisor ________________________________________________________ ___________
Department Chair ________________________________________________________ ___________
VPAA ________________________________________________________ ___________
