Name Enrolled Under (Last, First, Middle, Other)
Phone Number
___ ___ ___ - ___ ___ ___ - ___ ___ ___
___
Registration Term:
Spring Summer Fall 20
The student must be in good academic standing to be eligible to enroll in Special Problems, Independent
Study, or Research courses. The student must bring this completed form, with all signatures required
below, to the Registrar’s Office for processing; registration in this course may only be completed during
regular periods of registration.
Course Dates (
complete only if different from regular full-term dates
) _____ /_____ /_____ to _____ /_____ /_____
The Course Prefix and Number, Instructor’s name and T-number, and instructional method must be
provided by department offering the course.
To use this form, the course must already exist in the catalog as
an Independent Study, Special Problem, Directed Research, Thesis Research, Undergraduate Research, or
Internship course.
Prefi
x Number
Instructional
Method†
Instructor Instructor T-number Section CRN
T
* *
†FACE, WEB, MT49, MT99, INDV *Section number and CRN will be assigned by the Registrar’s Office.
FACE (100% classroom instruction), WEB (100% online instruction), MT49 (mixed technology with 1-49% online
instruction), MT99 (mixed technology with 50-99% online instruction), INDV (internships or non-web classes that do not
meet on ATU campus with individualized instruction)
Enter the course title as it should appear on the student’s transcript (25 character maximum, including spaces
and punctuation):
Explain the student’s need for taking a course of this nature:
Describe the objective/purpose of this problem/research/study:
Outline the procedures/method for investigating this topic:
Student Signature Date Instructor Signature (Graduate courses ONLY) Date
Dean or Department Head Signature Date Graduate Dean Signature (Graduate courses ONLY) Date
Overload Approval by Dean (if necessary) Max Hours Date
Revised
March 26, 2019
Winter Intersession
