Fillable Fillable Independent Study Form Independent Study Internship No Addendum (Central Connecticut State University)

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Fillable Independent Study Form Independent Study Internship No Addendum (Central Connecticut State University)

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Central Connecticut State University
Office of the Registrar
Independent Study/Internship Course Registration Form
Student Information
Name:
CCSU ID:
Email:
Street:
Telephone No.:
City/State/Zip:
Major:
Year
Term
Full/Part-Time
Ind Study/Internship
To be completed by student and faculty member:
Faculty Sponsor:
Faculty Load Credit:
Course Number:
Course Title:
Credit Hrs. (e.g., 3):
Average Weekly Contact Hrs. (e.g., 3, 4, 6):
CCSU Meeting Place (classroom, office):
List off-campus sites (if international, list country):
Planned readings and/or assignments; Criteria and schedule for assessing student performance
Is the course required for the student to complete their program? YES NO
If NO, please explain the justification for the independent study and the role this course will play in the student’s program.
I understand that registering for classes at Central Connecticut State University will generate charges that I am legally obligated to pay in
accordance with University payment deadlines and/or formal withdrawal policies. I also understand that any unpaid obligations may be referred to
the University’s contracted collection agency and that I will be responsible for any related collection costs in addition to the amount due
.
Student’s Signature
Date
Printed Name
Faculty Signature
Date
Printed Name
Department Chair Signature
Date
Printed Name
Dean of Academic Department Signature
Date
Printed Name
Dean of Graduate Studies Signature (if needed)
Date
Printed Name
Please print this form and submit it to the Office of the Registrar for processing.
Davidson Hall, Room 116, 1615 Stanley Street, New Britain CT, 06050, fax it to 860-832-2250, or email it to regstaff@ccsu.edu
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Fillable Independent Study Form Independent Study Internship No Addendum (Central Connecticut State University)

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Completed 18 July 2020

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