Fillable IndepStudyForm Independent or Individual Study Justification Form

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IndepStudyForm Independent or Individual Study Justification Form

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Independent or Individual Study Justification Form -
Please attach a current transcript to this form.
Student's Name: __________________________________________ Date: __________________________
Mailing Address:_________________________________________________________________________
Street City Zip
Semester: ____________________________________________ Year: ____________________________
Independent or Individual Study Title (attach an outline of the study with appropriate references):
Proposed instructor for the independent or individual study: ______________________________________
Reason(s) for requesting independent or individual study: ________________________________________
Individual Study Form is normally done a year in advance after obtaining agreement from proposed
instructor.
Student Signature___________________________________________
Instructor___________________________________________ Approve_______ Disapprove_______
Faculty Advisor ______________________________________ Approve_______ Disapprove_______
Department Chair ____________________________________ Approve_______ Disapprove_______
CC: Department Chair
Instructor
Faculty Advisor
Student
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IndepStudyForm Independent or Individual Study Justification Form

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Completed 19 November 2019

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