Academic Records Independent Study Form
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1Mills College – Academic Records
Independent Study Form
1. Independent study courses are offered for a maximum of 3.0 credits.
2. First-year students are not eligible to enroll in an independent study.
3. An independent study may not be used to fulfill Core Curriculum requirements.
4. This form cannot be processed if it results in an academic overload that has not already been approved by the Academic
Standing Committee (see catalog for maximum course loads).
5. The courses are officially numbered 095 for sophomores, 195 for juniors and seniors, 295 for certificate and graduate students
at the master’s level, or 495 for graduate students at the doctoral level.
6. A $1,550.00 non-refundable administrative fee is charged for all summer independent studies.
SECTION I
Mills ID: _____________________________________________________ Term/Year: ____________________
Name: ______________________________________________________________________________________
Last
First
M.I.
SECTION II
To show proven ability and extensive background in subject of study, list relevant courses, with grades and instructors' names:
Dept
Number
Title
Grade
Instructor
SECTION III
List the dept, course number, title, and number of credits for the proposed Independent Study.
________________
_______
_______
__________________________________
_________
Grade
CRN
Dept
Number
Title
Credit
P/NP
(
)
(Limit 20 characters; will be abbreviated if necessary)
(Max. 3.0)
OFFICE USE ONLY
A course description noting the scope of proposed study, including the aim of the project and material/technique to be used:
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
SECTION IV
Faculty: If this independent study is related to a course that utilizes Blackboard and is offered the same semester, the two
courses must be cross-listed. Please list the CRN, dept., section and title of the course with which the independent study should
be cross-listed, below:
___________
_______
________
________
__________________________________________________
CRN
Dept
Number
Section
Title
SECTION V
Please obtain the signatures listed below.
Student (Print): _______________________________ Signature: ____________________________ Date: __________
Major Advisor (Print): __________________________ Signature: ____________________________ Date: __________
Faculty Supervisor (Print): _______________________ Signature: ____________________________ Date: __________
The study outlined above has been discussed in this department, approved, and assigned to the faculty member whose signature appears above.
Department Head (Print): _______________________ Signature: ____________________________ Date: __________
Academic Records Use Only: SSASECT SFAREGS SSAXLST XL: ________________
Processed by: ____________ Date: __________________ Notes: _________________________________________________________
M:\M_Center\Restricted\Academic Records\FORMS\Forms In Use\independent_study_form_CCC.docx
Rev: 11/16
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