Individual Learning Agreement /
Independent Study Form
Independent Study/Directed Research Policies:
1. Students must be in good academic standing
2. Students must arrange the independent study with a full time Vanderbilt faculty member who has agreed to supervise and
grade this experience.
3. Registration for an independent study will not be allowed after the registration change period has ended.
4. Students may not repeat independent study courses for grade replacement.
5. The content of the independent study/directed research must not be the same as a regularly offered course. Study must
include substantial research or reading in an area not covered in the regular offerings of that department.
Course Title: (the project name for your independent/directed study 45 characters max; this can
be whatever you and your supervisor agree upon, and it will appear on your transcript)
# of credit hours
Subject area:
(i.e. HOD, PSY-PC, etc)
Course number:
(i.e. 3860, 7960, etc)
Semester and Year
(i.e. Fall 2020)
Instructor: (Please PRINT first and last name. Instructor must be a full-time faculty member)
Describe the nature of your individualized learning experience (Be as specific as possible, including a brief
description of the project/placement, and any required readings and assignments):
Describe your specific responsibilities:
Student Information (PRINT CLEARLY; all fields required):
Full Name:___________________________________________________ Student ID # (e.g. 000162030) ______________________
Classification: Undergraduate: FR____ SO____ JR____ SR____
Professional: M.Ed.____ M.P.P.____ Ed.D.____ Non-degree____
Anticipated Date of Graduation: Aug___ Dec___ May___ (year) 20_____
Major/Program: _____________________________________ Major Track(s), if applicable:_____________________________
Email Address:________________________________________@vanderbilt.edu
Individual Learning Agreement /
Independent Study Form
Basis for determination of final grade - Please provide a specific and detailed description of how your
faculty supervisor will evaluate your contribution in this experience. This could be regular benchmarks or
assignments to be completed throughout and/or a final project, presentation, literature review, or exam.
Deadline for submission of evaluation material(s):
Specify the arrangements, frequency, and location of meetings with the supervisor:
Student’s Name & Signature Date
Full-time Vanderbilt Faculty’s Name & Signature Date
Director of Undergraduate Studies’ (undergrads) OR Program Director’s (professionals) Name & Signature Date
OAS Use Only
OAS Signature Date
Please return to:
The Peabody Office of Academic Services 215 Peabody Administration Building Phone: (615) 322-8400
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