Petition Form For Undergraduate Special Study Course printable pdf download

University of California, Santa Cruz

PETITION FOR UNDERGRADUATE INDIVIDUAL STUDIES COURSE

(Academic Senate, Santa Cruz Regulation, 6.5, 9.1)

This form is to be completed, approved and filed with the department, college, committee or division office prior to the deadline established by the

sponsoring agency but no later than the last day to enroll in classes for the term in which the course is to be taken. Undeclared majors may not take

more than 7 credits of special approval courses per quarter. Students who are declared in a major may only take more than 7 credits of special approval

courses per quarter with authorization from their department. (Authorization is not required if special approval courses are part of a curriculum approved

by CEP, for example the Community Studies major.) The Individual Studies Course class number will be issued by the sponsoring agency at the time

the petition is approved. Completion of enrollment procedures for the course is your responsibility.

NAME ___________________________ STUDENT ID _______________

QUARTER __________ YEAR _______

EMAIL______________________ PHONE _____________ COLLEGE _____________

Check one:

UNDECLARED or

MAJOR ________________________ CLASS LEVEL:

❏ FR ❏ SO ❏ JR ❏ SR

❏

COURSE SPONSORING AGENCY___________________________ FACULTY SPONSOR______________________

STUDY SITE ADDRESS ___________________________________________________________________________

TITLE AND DESCRIPTION OF PROPOSED COURSE ___________________________________________________

_______________________________________________________________________________________________

EVIDENCE OF PREPARATION FOR SPECIAL STUDY (prior courses, readings completed, persons contacted) ______

_______________________________________________________________________________________________

DESCRIPTION OF WORK TO BE SUBMITTED FOR THIS COURSE ________________________________________

_______________________________________________________________________________________________

A written report (will) (will not) be required before credit is given for this course. For any course 198, a written report must be filed with

the sponsoring agency before credit will be assigned. THE LAST DAY FOR RECEIPT OF THIS REPORT IS ____________ (the last

day of instruction in the quarter except when an earlier date is specified by the instructor).

____________

ESTIMATED NUMBER OF HOURS PER WEEK: with faculty sponsor _______________ independently on project

INSTRUCTOR APPROVAL

COURSE SPONSORING AGENCY APPROVAL

Instructors may not require that an independent study be P/NP without the

approval of the Committee on Educational Policy. The P/NP grading option is

1)________________

___________________

available only for students in good academic standing.

Class Number

Course ID (Subject-Number-Section)

Letter

Pass/

Grade No Pass

2)________________

___________________

1) Credits: ❏ 2 ❏ 5

❏ 10 ❏ 15 ❏ other ___

❏

Class Number

Course ID (Subject-Number-Section)

3)________________

___________________

2) Credits: ❏ 2 ❏ 5

❏ 10 ❏ 15 ❏ other ___

❏

Class Number

Course ID (Subject-Number-Section)

3) Credits: ❏ 2 ❏ 5

❏ 10 ❏ 15 ❏ other ___

❏

_____________________________________

Department Chair, Provost, Dean, or designee

Date

_________________________________________________

Faculty Sponsor

Date

MAJOR DEPARTMENT APPROVAL (submit all signed petitions to major)

Departmental authorization is required if enrolling in more than 7 special study credits. Total number of special study credits _______________ .

_________________________________________________________________________________________________________________

Department Chair or designee

Date

NOTE: Enroll in this course via AIS using the course numbers listed above. Be sure to enroll with the grade option(s)

marked and approved by the faculty.

Student Signature______________________________________________________________________ Date ______________________________

Petition Form For Undergraduate Special Study Course

Related Articles

Related forms

Related Categories