Independent Study Request
Before submitting this form, please meet with the professor who will be leading this independent study and
have him/her collaborate with you on the objectives, assignments, and grading criteria. Then have him/her
sign the form indicating approval. You next need to submit the request to the office of Student Records, who
will then forward it on to the Academic Vice President for final approval.
*Please not that there is an independent study fee of $196/credit.
Student making request: Date:
Number of hours completed to date: Grade level status:
Major(s): Minor(s):
Proposed independent study title:
Does this independent study serve to take place of a required class in your major/minor that is not offered this
semester? If yes, which one?
Number of credits that will be earned upon completion: Semester completed:
Please list the student learning outcomes for this independent study. After completing this course the student
will be able to:
Please describe the major assignments for this independent study:
What is the grading criteria/distribution for this independent study?
Professor’s signature for approval of study:
Print name:
Academic Vice President’s signature for approval:
Total Cost: $ E-mailed:
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