Fillable form should be completed collaboratively by the student (College of Southern Idaho)

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form should be completed collaboratively by the student (College of Southern Idaho)

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Office of the Registrar
315 Falls Avenue
PO Box 1328
Twin Falls, ID 83303-1238
Phone: (208) 732-6795
Email: recrods@csi.edu
Last updated June 2016
Application for Independent Study
Name: _________________________________________________________________ CSI ID#: ________________
Independent study is designed to complement your major and cannot be used to complete requirements for a
regularly offered course. You may not use independent study to improve a grade you received in a class. This
form should be completed collaboratively by the student and instructor.
Course Information
Term
(Fall, Spring, Summer)
Year
Course Code
Number of
credit hours
Grading Basis
☐ Pass/Fail ☐ Letter Grade
Description of Proposed Study
Learning Objectives (What new knowledge, skills and abilities will the student have at the end of the study?)
Activities (The plan might include readings, interviews, discussion with a faculty advisor, or other activities as appropriate.)
Outcomes/Evaluation (How will the student’s learning be demonstrated and assessed?)
Timetable (Include interim mileposts such as advisor meetings, feedback on drafts, and final project completion. The
advisor and student can use this to gauge progress and provide feedback and support as needed.)
Office of the Registrar
315 Falls Avenue
PO Box 1328
Twin Falls, ID 83303-1238
Phone: (208) 732-6795
Email: recrods@csi.edu
Last updated June 2016
Approval by Academic Affairs
☐ Approved
☐ Disapproved
__________________________________________________________
Advisor Signature Date
☐ Approved
☐ Disapproved
__________________________________________________________
Department Chair Signature Date
☐ Approved
☐ Disapproved
__________________________________________________________
Instructional Dean Signature Date
Office of the Registrar Use Only
Registration Specialist ______________ ________________________________ Date ____________________________
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Completed 3 February 2021

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