Independent Study Form printable pdf download

Independent Study Form

CENTRE COLLEGE – INDEPENDENT STUDY FORM

PLEASE READ THE BACK OF THIS FORM CAREFULLY BEFORE COMPLETING

Name: _____________________________________ ID#: _______________

Major(s): ___________________________________ Class (Circle one): Junior

Senior

___________________________________ Cumulative Grade Average: ___________

Proposal for (check one):

Directed Study _____

Independent Study _____

Research _____

In (academic program): ________________

Circle: Fall

Winter

Spring

Summer

Number of credit hours to be awarded: _____

Total number of credit hours student will enroll in during the term of independent study: _____

Course Title (to be completed by instructor; 32 characters or less, including spaces and punctuation):

_______________________________________________________

Description of Study:

Justification for the Independent Study (to be completed by instructor):

Method of Evaluation (to be completed by the instructor):

Required Signatures

Instructor: ___________________________________________________ Date: ______________

Program Committee Chair: ______________________________________ Date: ______________

Associate Dean: _______________________________________________ Date: ______________

DEADLINES: Completed forms (including all required signatures) must be delivered in person by the

student to the Registrar’s Office. Normally, independent study forms should be submitted during the

registration period for the term of the study (in April for fall term independent studies and in November

for CentreTerm and spring term independent studies). However, the Associate Dean will accept forms for

review through the first week of classes for fall and spring terms and through the first day of classes for

CentreTerm.

(over)

Independent Study Form