Fillable form will not be processed without a syllabus.: (Shippensburg University of Pennsylvania)

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form will not be processed without a syllabus.: (Shippensburg University of Pennsylvania)

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BROWSE SHIPPENSBURG UNIVERSITY OF PENNSYLVANIA FORMS

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SHIPPENSBURG UNIVERSITY
REQUEST FOR INDIVIDUALIZED INSTRUCTION OR INDEPENDENT STUDY
INSTRUCTIONS
You must be in good academic standing to apply for individualized instruction or independent study. The course may not
be used to repeat or replace a course in which a grade of “D” or “F” was earned. To apply, you must first find a faculty member
who is willing to work with you on an individual basis. Complete Part I of this form and have the faculty member submit it for
approval. A syllabus must be attached showing course requirements, tentative schedule, and method of evaluation to be used. This
form will not be processed without a syllabus.
Individualized instruction-when you need to take a regular course during a semester in which the course is not offered.
These courses are generally restricted to students who have completed a substantial portion of their degree program and who
need the particular course to complete their degree requirements.
Independent study-must include some new experience of inquiry, evaluation, and/or creative activity. This experience must
be one which is not available through an established course, including individualized instruction.
PART I (to be filled out by student and signed by advisor or department chair):
Student Name: ____________________________SU ID #:__________________SU email:____________________
Undergraduate Graduate Major: ___________________________________________
Year: _______ Fall Spring Summer A Summer B Winter
Please provide detailed justification for request:_______________________________________________________
_____________________________________________________________________________________________
Student’s Signature: ____________________________________________________________ Date: __________
Advisor/Chair Signature: ________________________________________________________ Date: __________
PART II (to be filled out by department and college offering the course):
Requesting (check one): Independent Study Individualized Instruction
_____________________________________ Number of Credits:_____ Has the course already been taken? ______
(Course number and title) Yes No Grade
Syllabus attached (__________________________) (_______________________________) Date: __________
(Faculty Member Print) (Faculty Member Signature)
If the student has not met the restriction or pre-requisite associated with this course an override may be granted.
Yes No
Student is currently registered for how many credits? _____
Approved Denied ________________________________ Date: __________
(Department Chair’s Signature)
Authorization to raise max credits to: _____
Authorization granted to repeat previous grade of D/F course by College Dean
Approved Denied _________________________________________________________ Date: __________
(College Dean’s Signature)
Authorization granted to repeat previous grade of D/F course by Graduate Dean/Associate Provost
Approved Denied _________________________________________________________ Date: __________
(Graduate Dean/Associate Provost)
Course Code: ________________ Entered by: ___________________ Date: _____________________________
Revised Date: 7/20/2016
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Completed 26 August 2020

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