Year: 20____
Semester : Fall Winter Spring Summer
Submit to Registrar’s Office (123 White Hall) once all signatures are obtained.
Revised Sept.-2017
The Registrar’s Office only needs this page in order to register you for the course. Your supervising faculty member will have a contract that you need
to complete that will detail the scope of work for the independent study. The contract is between you and your supervising faculty member.
Student’s Full Name
9-Digit Student
Student’s Major
3-Letter Course Prefix
3-Digit Course #
Credit Hour
Part of term
Course title exactly as you wish it to appear in your transcript:
Will this course rquire an ENGAGE shell? YES NO
Courses MUST be approved and added before the end of the drop/add period.
Student acceptance of charges and responsibilities:
The Registrar’s Office will notify me at my Utica College e-mail address of any problems with this registration:
o If I have a hold on my account, I will not be registered for the independent study.
o If adding this independent study will exceed my maximum hours, I will need to request an increase of my maximum hours or drop a
Independent Study courses are charged at the higher Day rate, even during summer and winter sessions.
I accept responsibility for ensuring that all courses for which I register are appropriate to my degree program.
I accept responsibility for all charges incurred as a result of my registration.
I understand that charges and registration are available for viewing on Banner Web.
I am responsible for the accuracy of all information I submit to the College.
I agree to notify the Registrar’s Office in writing of any withdrawal, or other change that affects my enrollment status in any class or be subject
to all charges.
If charges are incurred while attending and it should be necessary for Utica College to use a collection agency, which is subject to the Fair Debt
Collection Practices Act, I agree to pay all collection costs and attorney's fees.
In the event I qualify for Title IV federal funds, I authorize the College to use these funds to pay for all allowable charges beyond tuition, fees,
room and board. I understand that due to federal regulations, my financial aid package is based upon a minimum registration requirement after
drop/add period. If minimum requirements are not met, I will not be eligible for certain aid programs and will be responsible to pay any balance
in full prior to participating in future registration periods or the release of transcripts.
Traditional campus students who do not pay the balance in full will be automatically enrolled in a payment plan and charged a deferred payment
If I fail to meet payment arrangement deadlines, I will experience delays in finalizing my registration, I may be dropped from my courses, and
if applicable, may be removed from campus housing and have my meal plan canceled.
Academic deadlines are posted on the College website. Links are available from the Registrar’s home page:
If I withdraw after the deadline, I will be given a grade of WF, which will calculate as an “F” in my GPA.
Student Signature (REQUIRED):________________________________________________ Date:
Faculty Approvals:
Supervisor Name (PRINT):
Supervisor Signature:
Chair/Director Signature:
Dean’s Signature:
Once all signatures are in place, please submit to the Registrar’s Office (123 White Hall) to process.
Registration Completed: CRN: __________ Date Registered: ______________ Initials: ______________
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