Independent Study Authorization Form
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1
2INDEPENDENT STUDY AUTHORIZATION FORM
Aviation Technology
Purdue University
(NOTE: A maximum of 6 credit hours of independent study is permitted on any program plan of study)
(Please type or print all information clearly)
Student Name ____________________________________________________
Student ID # ______________________
Number of independent study credits already completed:
________
I hereby request permission to enroll in AT _______ for ______ credits of independent study during the
Fall
Spring
Summer
semester of 20____-20____.
(circle one)
I plan to pursue an independent study project of the problem, _________________________________________________________
___________________________________________________________________________________________________________
(Please insert title of course)
I will submit all deliverables by: __________________________________
Date
_______________________________________
_________________________
____________________
Student's Signature
Printed Name
Date
I request that credit apply to:
Bachelor's
Master’s
Ph.D.
Non-degree Study
(Circle one)
I am willing to guide the independent study outlined in the attached prospectus and I agree to the deadlines indicated above.
_______________________________________
_________________________
____________________
Professor in Charge of Instruction Signature
Printed Name
Date
Enrollment in the above independent study is consistent with the degree objectives of this student and is
on
not on
his/her plan of study. This student will not exceed six (6) credit hours of independent study on his/her plan of
study with this enrollment.
_______________________________________
_________________________
____________________
Academic Advisor’s Signature
Printed Name
Date
Approved
Not Approved
_______________________________________
_________________________
Curriculum/Graduate Committee Chair Signature
Date
Department Head approval required only when approval is granted by the Curriculum/Graduate Committee
Approved
Not Approved
_______________________________________
_________________________
Department Head Signature
Date
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