SEP Graduate Independent Study Request Form
Independent Studies focus on content area outside of what is offered as part of the regular curriculum, and provide
an educational experience equivalent to regularly taught courses. Independent Study may be granted for content
included in a regularly offered class only in the case of extenuating circumstances, such as a program change. This
form must be submitted and approved at least one month prior to the end of the semester preceding the directed
study. A maximum of six semester hours may be taken as independent study within a graduate degree.
Instructions: Consult with and obtain signatures from your faculty advisor and potential supervising professor
before submitting this request. Submit the completed form to the appropriate Director (EDUC: Dr. Eder, COUN:
Dr. Freeman-Gutierrez, OUTL: Dr. Tilstra). The respective program council will consider the request. If
approved, you will then complete the appropriate SAU form (petition for directed study) to be submitted to Records.
Name: ____________________________ I.D.: # ________________________________
Phone:____________________________ Email: ________________________________
Date: _______________ Hours completed at Southern: ____________ Cum. GPA: ______
Advisor: _____________________ Major/Degree Program: _________________________
Semester: Fall____ Winter _____ Summer _____
1. How many credit hours are you seeking to earn? _________
2. What are your learning goals and objectives? State them in measurable terms.
3. What learning activities will you employ and how long will you spend in each activity?
(note: 45 clock hours are required for each hour of academic credit earned)
Type of Learning Activity Time Allotted
a. Literature Review
b. Reading of Textbook & Professional Literature
c. Original Research
d. Interviews
e. Writing & Reflection
f. Conferring with Supervising Professor
g. Other:
4. Type of final product to be produced and method of delivery or presentation at
conclusion of course. Please describe in detail.
5. Textbook(s) to be used:
6. Other research or learning resources needed:
7. Which professor are you requesting to supervise this directed study/independent study?
Student Signature ____________________________ Date ____________________
Approval Signatures:
Advisor _____________________________ Date _____________________
Professor ___________________________ Date _____________________
Approval date by respective program council & signature of program coordinator
Signature ____________________________ Date ______________________
Dean _______________________________ Date _____________________