Directed Independent Study
DIS
Student Information
First Name ID Number
Course Information
Subject
Credit Hrs. Semester
Short Course Title (26 characters max) DIS:
Describe Requirements for
Final Evaluation
Faculty Instructor Type/Print Name
Faculty Instructor Signature
Approvals:
I agree to the course description and
requirements as stated above and
request to be enrolled in the course.
Student
Signature
Descriptive Course Title:
Course
Yes No Does this course require travel outside of the U.S.?
If yes, student(s) will need to obtain and complete an
International Academic Travel Packet through the
Office
of International Programs.
International Travel
Office of International
Programs Approval:
Course Description
Year
Graduate Coordinator Signature
Graduate School Signature
Please return the completed form to the Graduate School, second floor James Hall
Last Name
Main Campus
Extension Campus (800
sections)
Select One
2 0
click to sign
signature
click to edit
click to sign
signature
click to edit
click to sign
signature
click to edit
click to sign
signature
click to edit
click to sign
signature
click to edit