OFFICE OF THE REGISTRAR

INDEPENDENT STUDY APPROVAL

             _____ _____ _____                                                                                                                                       Identification Number                                                                            Date 

             Student Name: Last                                                    First                                           Middle Initial   

             Independent Study Course Information: 

            __________        __________     ___________________________________    ____________
             CRN                   COURSE #                TITLE                                                        CREDITS

             Check one:         ( )    Fall                     ( )   Spring            ( )    Summer

             Your proposal for an Independent Study Project must address each of these five topics:

             1.          Learning Objectives: What will you learn to do, know, or understand as an outcome

                          of this project?

             2.          Activities: What will you do? Be specific, indicating what you will observe,

                          measure, perform, etc.

             3.          Resources: What will you need for the project? Include bibliography, people,

                          agencies, budget and equipment.

             4.          Evaluation: What will you produce or perform which your faculty sponsor will

                          evaluate for a final grade? How frequently will you confer with your faculty sponsor?

             5.          Preparedness: How can you verify your capacity to carry out this project? Include

                          instruction, experience and ambition.

                                                                                                                                                                                                     Approval of Instructor                        Approval of Department Chair

                                (who will supervise you)                        (in which course will be offered)