Fillable Local or Cell Telephone Number APPLICATION FOR INDEPENDENT (State University of New York at Plattsburgh)

Fill Online, Printable, Fillable, Blank Local or Cell Telephone Number APPLICATION FOR INDEPENDENT (State University of New York at Plattsburgh) Form

Use Fill to complete blank online STATE UNIVERSITY OF NEW YORK AT PLATTSBURGH pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Local or Cell Telephone Number APPLICATION FOR INDEPENDENT (State University of New York at Plattsburgh)

On average this form takes 7 minutes to complete

The Local or Cell Telephone Number APPLICATION FOR INDEPENDENT (State University of New York at Plattsburgh) form is 3 pages long and contains:

  • 0 signatures
  • 9 check-boxes
  • 25 other fields

Country of origin: US
File type: PDF

U.S.A. forms for State University of New York at Plattsburgh

BROWSE STATE UNIVERSITY OF NEW YORK AT PLATTSBURGH FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
________________________________________________________ _________
___________________________________ ________
_____________________________________________ ________
_____________________________________________ ________
APPLICATION FOR INDEPENDENT STUDY/RESEARCH
SUNY Plattsburgh
Please type information in the form below then print page to obtain signatures.
STUDENT INFORMATION
Student’s Name: Last Name, First Name Student’s ID# Cumulative GPA
Local or Cell Telephone Number
Major(s) Minor(s) Class Level
Total number of credit hours to be registered for this semester, including proposed independent study:
Total number of independent study credits completed prior to this proposal: ___________
undergraduate graduate
COURSE INFORMATION
Course Subject/Number (e.g., ANT#99, where # can be 1 to 5 depending on level, or departmental research number): ______
Title of Independent Study/Research: ______________________________________________________________
Number of Credit Hours for this Independent Study/Research: ____________________________________________
(Faculty sponsor must attach justification for the number of credit hours awarded.)
Date Project Begins: __________________________________ Date Project Ends: _______________________
Hours of Effort per Week: ____________________
Location (select one): Main Campus Branch Campus (ACC) Miner Center HVCC Other (list):________
Faculty Sponsor's Name: __________________________ Sponsor's Campus Address/Phone: ____________________
Explain how this course is applicable toward the student's degree program:_______________________________
Satisfies Major Requirements; In Major but Elective; Satisfies Minor Requirement; College Elective Credit
(Note: If the independent study is a deviation/substitution for a course in the student's program, a Deviation Request Form
must accompany this application.)
Signatures must be obtained in the following order:
COURSE APPROVAL
Yes No
Faculty Sponsor
Indicate Approval and Option in Email
Date
Professor/Associate/Assistant Lecturer Adjunct Other
Academic Advisor _____________________________________________________ Date:_________
Indicate Approval in Email
Chair (of department offering course):
Indicate Approval in Email
Date:
Dean (of division offering course): ______________________________________ Date: ________
Indicate Approval in Email
CREDIT OVERLOAD APPROVAL (see I.B. in Guidelines and Procedures on reverse side)
Yes No
Chair (of student's major):
Indicate Approval in Email
Date:
Dean (of student's major):
Indicate Approval in Email
Date:
Dean retains full copy and distributes first-page copies to student, advisor, and Registrar; full copy to Faculty Sponsor VPAA: 3/2020
GUIDELINES AND PROCEDURES FOR INDEPENDENT
STUDY/RESEARCH APPLICATION
I. GUIDELINES
A. To be eligible for independent study undergraduates should have a 2.5 cumulative grade point average and
graduate students should have a 3.25 cumulative grade point average. If GPA requirement is not met,
discussion with your advisor, chair, and dean should occur prior to submitting the form to your faculty
sponsor.
B. Undergraduates may not take more than 18 credits per semester including the independent study, and
graduate students may not take more than 15 credits per semester including the independent study, except with
permission from the student's advisor, the department chair and dean of his/her major. Permission is also
required to exceed 15 credits for all summer sessions combined or to exceed 7 credits for the winter
session.
C. No more than nine credits of independent study may be applied to a graduate degree.
D. To receive credit for independent study in any semester the Application for Independent Study/Research
must be approved and received in the dean's office by the end of the first week of the semester (or first week
of the summer or winter session).
E. The ending date of the independent study must be within the term it was initiated; projects spanning more
than one term must be subdivided, with separate applications submitted.
II. PROCEDURES (Please print or type responses)
A. Prior to preparing the final proposal for your independent study or research, discuss the idea and a draft of
the proposal with your sponsor and advisor.
B. Prepare the final independent study or research proposal including the following:
1. Statement of the problem, question, or investigation with specific learning objectives to be pursued; this
is the "what" of the proposal.
2. In one sentence, state the purpose or rationale of the study.
3. Procedure to be followed (lectures to be attended, books/papers to be read, research to be conducted,
technical processes to be used); this is the "how" of the study. Supply references to sources as
appropriate.
4. Method of supervision and/or interaction with faculty sponsor (how often you will meet with your
sponsor: describe the nature of the meetings or supervision).
5. State the products of the work that will be used for grading (reports, talks, demonstrations you will
give, tests, papers, etc.) for determining a grade and the grading system to be used — (A-E or Pass/Fail).
6. Note: If your proposed study involves research with human or animal subjects you must also complete an
application for research with human or animal subjects. Contact the Office of Sponsored Research, Kehoe
815, ext. 2155.
C. Obtain all required signatures.
________________________________________________ ________________
________________________________________________ ________________
STATE UNIVERSITY OF NEW YORK AT PLATTSBURGH
Registrar’s Office
Student’s Name (Print): _______________________________________
STATEMENT OF UNDERSTANDING OF THE FAMILY EDUCATIONAL RIGHTS AND
PRIVACY ACT (FERPA)
I understand by virtue of my employment or assignment by SUNY Plattsburgh as a teaching assistant,
graduate assistant, or in another capacity such as work-study or temp-service student that I may have access to
records which contain individually identifiable and confidential information about former or currently enrolled
students, the disclosure of which is prohibited by the Family Education Rights and Privacy Act of 1974
(FERPA). I acknowledge that I have read SUNY Plattsburgh’s FERPA compliance policy and that I fully
understand that the intentional disclosure by me of protected information to any unauthorized person(s) could
subject me to criminal and civil penalties imposed by law. I further acknowledge that such disclosure may
also violate SUNY Plattsburgh’s FERPA compliance policy and could constitute just cause for disciplinary
action including termination of my employment or assignment or a failing grade in the work-related course
regardless of whether criminal or civil penalties are imposed.
Student’s Signature
Date
Supervisor’s Signature Date
Record Retention: Three years after the term in which the student signs this form.
Record Retention: Three years after the term in which the students signs this form.
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Local or Cell Telephone Number APPLICATION FOR INDEPENDENT (State University of New York at Plattsburgh)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 27 August 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document