Pitzer College Office of the Registrar
DIRECTED INDEPENDENT STUDY FORM
Student
Name
ID
#
Contact
Phone
Number:
(
)
Planned
Grad
Year:
Student
E-Mail
*You have not officially declared your major
List
Major(s)
or
Undeclared:
until a complete Major Declaration form has
been submitted to the Registrar’s Office.
I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I
Title of Independent Study (32 characters to meet the transcript title size)
Full Course Half Course
Semester: FALL SPRING SUMMER Year: 20
Instructor’s
Field Group
Will
this
course
be
used
to
fulfill
an
Educational
Objective?
If
yes,
which?
*
Code:
(HUM) Humanities; (NAT) Natural Science (must be approved by Joint Science); (QR) Quantitative
Reasoning;
(SOC) Social Science; (WRI) Writing Intensive; (SRP) Social Responsibility (for students who entered prior to
Fall ’16); (SJT) Social Justice Theory; (SRX) Social Responsibility
Praxis;
(IU-G) Intercultural Understanding
Global/International; (IU-L) Intercultural Understanding
Local/US
Attach a separate sheet with the equivalent of a syllabus for your proposal. The syllabus should
include and clearly identify the following:
A detailed description of the course goals.
A schedule of meetings with the faculty director.
A reading list (if incomplete, indicate the types of readings and number of pages per week).
A list of assignments. Describe in detail each assignment, including the type of project or paper (including length),
and due dates.
The means of evaluation (describe how the faculty director will determine your final course grade).
PLEASE NOTE: In order to receive course credit, independent studies must contain an academic component. Merely
completing hours at an internship, placement, or extracurricular activity is not sufficient to gain academic credit.
Student Signature Date
----------------------------------------------------------------------------------------------------------------------------------------------------------------
Faculty Section: (Required- must be filled out by Faculty Director and Advisor)
Grading Type (Letter grade or Pass/No Credit):
Course Type (required for Pomona faculty only):
Directed Reading (DR), Ind. Research (IR) or Research Assistantship (RA)
Instructor Name (Print) Instructor School Instructor Signature Date
Advisor Name (Print) Advisor Signature Date
Curriculum
Committee
Approval:
CID:
Entered:
7/25/2016
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