Fillable CCSU INDEPENDENT STUDY COURSE REGISTRATION FORM 06050

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CCSU INDEPENDENT STUDY COURSE REGISTRATION FORM 06050

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The CCSU INDEPENDENT STUDY COURSE REGISTRATION FORM 06050 form is 1 page long and contains:

  • 2 signatures
  • 8 check-boxes
  • 38 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Central Connecticut State University

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Registrar’s Office/Enrollment Center --Central Connecticut State University, New Britain CT 06050
INDEPENDENT STUDY COURSE REGISTRATION FORM for Graduate and Undergraduate
Students
Name:
CCSU ID:
Street:
Phone: (H): ( )
City/St/Zip:
(W): ( )
Country:
Date:
Course Type
Academic Term
Year
Student Class
Student Status
Independent Study
Internship
Fall Spring
Summer Intersession
First Year Student
Sophomore
Junior
Senior
Graduate Student
Full-time
Part-time
The sponsoring faculty member completes this section with the student:
Faculty Sponsor:
Course Number (e.g., ART 498, PSY 499):
Number of Credit Hrs. (e.g., 3, 4, 6):
Average Weekly Contact Hrs. (e.g., 3, 4, 6):
Meeting Place (classroom, office, or other location):
**Description of Course and Its Relationship to the Student's Program:
**Evaluation Schedule:
**Planned Readings and Other Assignments:
**Means for Evaluation:
Required Independent Study Course Registration Written Agreement/Approvals:
Submitted by ____________________________ _______________________Date: __________________
Student’s Signature Printed Name
Sponsored by _________________________________ ____________________________Date:______________________
Faculty Member’s Signature Printed Name
Approved by _________________________________ _____________________________Date: _____________________
Department Chair’s Signature Printed Name
______________________________ ____________________________ Date: _____________________
Dean of Academic School’s Signature Printed Name
______________________________ ____________________________ Date: _____________________
*
Dean of Graduate School’s Signature Printed Name
*Required when an independent study or internship course is requested by a graduate student
**If additional space is needed for these sections, please attach a second page
Effective 02/2011. Distribution of Completed Form: original-Enrollment Center or Registrar’s Office; copies-faculty member, chair, student, academic
dean, Graduate School (if applicable)
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CCSU INDEPENDENT STUDY COURSE REGISTRATION FORM 06050

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Completed 25 December 2019

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