Fresno State
Updated 10/2014
Independent Study Approval Form
Studies In Performance
Music 210
In order to take private lessons, complete this form, obtain the signature of your instructor and
return the form to the department office. Confirm your enrollment by registering for the course on-
line.
Date: Fresno State Email: @mail.fresnostate.edu
Name: Fresno State ID:
Last Name First Name MI
Address:
Cell Phone: Other Phone:
Supervision Course (Number/Title) Music: 210
Schedule Number Units: 2
FALL SPRING SUMMER
1. The above student has a overall grade point average of 3.0 or higher
2. Although the above student lacks a 3.0 overall grade point average, it is my belief that
he/she will benefit from this study.
Supervising Instructor (Type or Print):
Signature of Supervising Instructor:
Signature of Department Chair:
Additional comments:
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