Registration in a Special Course
Name_________________________________________ Student ID#________________________________
Date________________ Course to be taken during term: ____________________ Year: _______________
Number of credits earned toward your degree: __________
Type of course: □ Independent Study (a course number XXX 490/590)
□ A course taken independently (a course listed/described in the catalog)
Course Number___________ Course Title________________________________ Credit Hours_____________
Date course begins:____________________________ Date course ends: ______________________________
Reason for taking this course in the manner: _____________________________________________________
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__________________________________________________________________________________________
Brief description of course with a syllabus attached for an independent study course (XXX 490/590):
__________________________________________________________________________________________
__________________________________________________________________________________________
Total hours registered after adding course: _______________________________________________________
Please obtain signatures in the following order:
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Student Signature Date
___________________________________________________________ ______________________________
Advisor Signature Date
___________________________________________________________ ______________________________
Instructor of Course Date
___________________________________________________________ ______________________________
Department Chair of Instructor of course Date
___________________________________________________________ ______________________________
Dean Signature Date
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