Student Request for Independent Study/
Graduate Research Course

Student Name: ______________________________ Phone # _________________

Soc. Security #:_____________________________

Requested Instructor:_______________________________

Trimester: __________ Year: ________________________ Credit Hrs. ____________

Check Appropriate Course: (Approved by Division Chair)

____Independent Study (470) Discipline: _____________ Ref. No: _____________

____Graduate Research (870) Discipline: _____________ Ref. No: _____________

PLEASE SUBMIT ON AN ATTACHED SHEET, A WRITTEN PROPOSAL FOR YOUR INDEPENDENT STUDY/GRADUATE RESEARCH PLAN.*

METHODOLOGY: What kind of study is it? How will you do the study?

SPECIFIC OUTCOME, UPON WHICH EVALUATION WILL BE BASED:

MEETING DATES WITH INSTRUCTOR (If applicable):

Approvals:

Instructor: ______________________________ Date:_______________

Division Chair:___________________________ Date:_______________

*Independent Study/Graduate Research enables a student to pursue individual research and reading in a field of special interest under the guidance of a faculty member. A written proposal for an independent study, planned and developed by the student, must be approved by the division chairperson in consultation with the faculty sponsor.

Independent study credit may be used to meet elective credit only. A maximum of nine undergraduate credit hours and six graduate credit hours of independent study may be applied to degree requirements. Individual colleges and programs may have more restrictive policies. A student may enroll for a maximum of three credit hours of independent study in any one trimester.

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