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TermStudent IDName_________________________________________________________ ____________________ ______________
CellEmail________________________________________________________ ____________________________________________________
AdvisorAcademic Program______________________________________________ _______________________________________________
Note: GPA must be 2.5 or above.Class: Jr. Sr. Cumulative GPA______________
Students must be of Junior or Senior status, meet the GPA minimum, and be matriculated into a Nazareth College
degree program in order to request enrollment in an Independent Study or Tutorial course.
INDEPENDENT STUDY Credit hours: 1
2 3
Course Number_________________________________________________________________
Department Prefix and Number
Course Title IS (max. 25 characters)
Independent Study: Syllabus must be attached: a concise statement of what you propose to do – include
suitability of topic, readings—bibliography, availability of resources, research—kind, extent, field work, if
any. Information about activities, outcomes, and evaluation mechanisms must be included.
Does this course reside in the department of your major? YES_____ NO_____
If no, please list courses you have taken in the department of the IS course, and the grades you received in those courses.
Why do you wish to pursue this Tutorial or Independent Study?
On what basis do you expect to be evaluated for this course?
Student_________________________________________________________________________________________________________________ Date___________________________________
PRINT NAME SIGNATURE
Faculty Supervisor____________________________________________________________________________________________________ Date___________________________________
PRINT NAME SIGNATURE
DateDept Chair of IS/TUT__________________________________________________________________________________________________ ___________________________________
PRINT NAME SIGNATURE
All signatures must be obtained by the student and proposal submitted to Registrar by the end of the first week of classes.
REGISTRAR: COURSE CREATED Date/Initials________________________________ STUDENT REGISTERED Date/Initials_____________________________
Office of the Registrar • Nazareth College of Rochester • 4245 East Avenue • Rochester, NY 14618 • 585-389-2816
TUTORIAL COURSE - Course exists in catalog but not offered in term needed
Course Number__________________________________________________________________ Credit Hours_________
Department Prefix and Number
Course Title TUT
Tutorial: Attach an outline of course content and organization (if different from normal course organization –
most recently used syllabus may be submitted).
Also include information that clarifies number/length of
individual meetings, as well as how readings, practice and other activities will satisfy course requirements.
UNDERGRADUATE TUTORIAL -or-
INDEPENDENT STUDY COURSE PROPOSAL
IS - REMEMBER TO ATTACH SYLLABUS
