_______________________________________________________________________________________________________________________________________
This form is to be used only if a course was not originally scheduled this term and a faculty member is willing to offer a regular
course on an independent study basis for a specific student, or special arrangements are made for an independent study project. A
syllabus is REQUIRED. This form is NOT to be used for topics courses ending in 90.
Pr
ovide all the information which is available about the special arrangement. Signatures are required (see bottom of form) to
approve enrollment in the course. The course will be created and the student will be registered by the Registrar’s Office.
Inde
pendent study courses cannot be used to satisfy Liberal Arts and Science Curriculum (LASC) requirements.
Student’s Name Star or Dragon ID Email
Subject Course Number Term/Year course will be offered
Course Title Credits Instructor’s Name
Ra
tionale Required (Explain the need to offer the course on an independent study basis):
Check one: Regular Departmental Course Offering Independent Study (Please use X97 as course number)
Approval Signatures
Student’s Signature: ____________________________________________________________________________ Date: _____________________
Instructor’s Signature: __________________________________________________________________________ Date: _____________________
Department Chair’s Signature: ____________________________________________________________________ Date: ____________________
Dean’s Signature: ______________________________________________________________________________ Date: _____________________
Registrar’s Signature: ___________________________________________________________________________ Date: _____________________
Return form to:
Minnesota State University Moorhead Registrar’s Office
Owens Hall 210 | 1104 7
th
Ave S | Moorhead MN 56563
Phone: 218.477.2565 | Fax: 218.477.2941 | Email: Registrar@mnstate.edu
Minnesota State University Moorhead is an equal opportunity educator and employer and is a member of Minnesota State System.
Course Approval Form
Internships are scheduled as a regular course. Do not use this form.
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