PETITION TO CREATE AN INDEPENDENT MODULE – CENTENARY COLLEGE OF LOUISIANA
Student should submit completed petitions to the Registrar’s Office no later than November 15 for an independent
module they intend to complete in the spring term, and no later than April 1 for an independent module they intend to
complete in a summer or fall term. These deadlines are firm, please be attentive to them.
Date this petition received
Campus Box #
Email (for communications about petition)
Expected Graduation: Year
Degree Plan on file with the registrar
Dates of when you plan to actually complete this independent module?
When do you plan to register for this independent module? Semester
My reasons for requesting an independent module
: (Feel free to attach any necessary supportive material. Describe the
compelling reasons the committee should consider approval of your substitution for the regular May Module.)
Attach a complete syllabus for your proposed independent module course. Your syllabus must include:
― a course description, including clearly defined learning goals/outcomes;
― the hours of credit desired and a time audit justifying those credit hours;
― the name and position of the faculty member who will be supervising and evaluating the independent module;
― the tentative locations and dates of all learning activities, and which activities and meetings are already confirmed/arranged and
which are not yet firm;
― the methods of student evaluation (e.g., papers, presentations, journals, etc.); and
― the required readings and other instructional foundations (e.g., films, discussions, interviews, etc.).
Please note: Independent modules are “concentrated study for a short period on topics of… interest not normally offered.”
Independent modules that involve travel off-campus or out of the country may be subject to Centenary’s insurance regulations.
If you are also seeking CU credit for this independent module, you should attach a 2-3 page typed proposal which
explains the cultural experience you intend to have and addresses all of the following questions listed below:
― What culture will you study?
― How is this culture different from your own?
― Why would you like to study this particular culture? Why is it important to
― What knowledge, personal gratification, and/or perspective do you hope to gain from this intercultural experience? Be specific.
― If you are proposing a module inside the US, explain how the culture you are applying to study is substantially distinct from
mainstream US culture.
Any Independent Culture Project must be completed under the guidelines for the CULTURE program.
― For students studying a sub-culture in the USA, they must complete no fewer than 45 hours of activities dedicated to learning
about or from the intended culture of study.
― For students studying a culture in another country, they must spend 14 days within the culture, inclusive of travel time. Those
interactive time with the unique population with the intended culture of study. Examples of interactive
activities include, but are not limited to: conducting interviews, attending traditional services/ceremonies, volunteering with a
group associated with or supporting the culture under study, etc.
Please note: If your proposal is approved by the Trek Committee, you will be required to complete additional paperwork with both
the Office of Global Engagement and Centenary’s Department of Public Safety
Other interested parties can include or attach their comments and documentation to this form:
(The committee welcomes
any details, supporting documentation, regardless of whether or not you approve of the action requested.)