CHABOT-LAS POSITAS COMMUNITY COLLEGE DISTRICT
Office of Academic Services
INDEPENDENT STUDY CONTRACT (Other than regular courses)
(This contract is due to the Vice President of Academic Services by the 17
th
day of instruction)
SUBJECT AREA: _______________________________________ SEMESTER ___________________ YEAR __________
(e.g. English, Mathematics, etc.)
STUDENT’S
FULL NAME* ___________________________________________ W # _____ _____ _____ _____ _____ _____ _____ _____
*(Note: attach list if there is more than one student in this contract with this instructor; Include W# and signature of each student)
FACULTY NAME (Please Print) ___________________________________________
NUMBER OF .5 = 26
HOURS PER WEEK DAY(S)
UNITS 1.0 = 52
and
REQUESTED: 2.0 = 105
HOUR(S)/TIME(S)
TITLE OF INDEPENDENT STUDY PROJECT: (Include topics and/or projects)
STUDENT LEARNING OUTCOME (SLO): Upon successful completion of this study, a student should be able to:
Description of what the student will be expected to do:
Responsibilities assumed by the instructor: (What commitments regarding meetings, materials and other assistance does the
instructor make?)
INDEPENDENT STUDY BEGIN DATE:_________________________ EXPECTED DATE OF COMPLETION:______________________________
_________________________________________________________ ____________________________________________________________
FACULTY SIGNATURE DATE STUDENT SIGNATURE DATE
EXPECTED TOTAL HOURS OF
CONFERENCE AND STUDY
(Contact hours plus Independent Study)
APPROVAL OF AGREEMENT:
__________________________________________________________
DIVISION DEAN DATE
__________________________________________________________
VICE PRESIDENT, ACADEMIC SERVICES DATE
Assigned by Office of
Academic Services
Any supporting documentation (i.e. Summary of Completed
work) should be retained by the Division office.
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signature
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