SPECIAL PERMISSION FOR INDEPENDENT STUDY
(Please type or print legibly.)
Please review the Guidelines printed on the reverse side of this form and any departmental information before completing the request form.
SKIDMORE ID________________ NAME ________________________________________________________
CLASS _______
MAJOR _________________
GPA _______
SEMESTER ________________
TOTAL CREDIT HOURS REGISTERED: ______________
(Total CR hours + Ind. Study hrs CANNOT exceed 18, unless Approved Overload Form has been submitted)
Department or Program Supporting Independent Study is only filled in here if not listed below: _________________
371(3cr)
Course Number:
(Please Note: All independent studies are 371 (3cr) unless otherwise listed below.)
(circle department AND number of credits)
AH = Art History / CC = Classics / GW = Gender Studies / HF = Honors Forum / IA = International Affairs /
MB = Management & Business / MF = Media and Film Studies / PY = Physics 1 2 3 4
AA = Arts Administration / EX = Exercise Science 1 2 or 3
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(circle number of credits)
ED = Education Studies 1 or 3
ES = Environmental Studies 1 2 3 or 6
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(circle course number)
AR = Art AR 371 (4cr)
AS = Asian Studies AS371 (3cr) / AS372 (3cr)
GN = General GN-271 / GN-371 (circle number of credits) 1 2 3 4
ID = Interdisciplinary ID-271 / ID-371 (circle number of credits) 3 or 4
PS = Psychology PS371C(3cr) / PS371D(4cr) / PS373C(3cr) / PS373D(4cr)
LI = Library LI371 (1cr) (only offered for 1 credit)
If Foreign Language, is it being taught in English? Circle one: Y or N
Project Title: ___________________________________________________________________
REGISTRATION INFORMATION:
1.
Do you wish to register for this course satisfactory/unsatisfactory (S/U)? Yes / No
2.
Is this course to be counted toward your major or minor? Yes / No. If yes, does it meet a specific category
requirement? Yes / No. Please specify _____________________
3.
Will this course follow the syllabus of an existing approved Skidmore course? Yes / No. If yes, which course number __________. Please
attach the Curriculum Committee approved syllabus. (Course # will be used on registration and transcript forms with the title having (IND)
at the end of it.)
Student’s Signature: _____________________________ Date: _______
Instructor’s Approval: ___________________________ Date: _______
Print Instructor’s Name________________________
Advisor’s Signature: ____________________________ Date: _______
Chairperson’s Approval: _________________________ Date: _______
[Complete Proposal on Reverse Side]