Form 337-7204 - Independent Study Registration Form printable pdf download

FFICE OF THE

EGISTRAR

337-7204

NDEPENDENT

TUDY

EGISTRATION

ORM

A student may take an independent study course (198/298/398/498) in an area of interest that is not

available in a regularly offered course, or under special circumstances (such as the unavailability of a

required course), a student may take a regular course as an independent study. All independent study

applications require the approval of the instructor, department chair, and advisor. Independent Study is a

full-unit course and students may not receive credit for more than one independent study course per

quarter, nor for more than two independent studies during degree completion. Applications are due in the

Registrar’s Office by 5:00 p.m. Friday of the first week of the quarter and require the approval of the

instructor, department chair, and advisor.

ID# _________ Name: _______________________________________ Anticipated Grad:

FA WI SP ________

(Print legibly)

(circle one)

Year

Major(s) __________________________________ Advisor(s) ______________________________

(Signature required below)

Department of

Director/

Registration: __________________________

Instructor: _________________________________

(Signature required below)

Quarter of Registration:

Registration: ____ 198 ___ 298 ___398 ___498

FA WI SP

_________

(NOTE: Registration number is based on level of instruction)

(Circle One)

(Year)

Regular course substitute:

___________________________________________

(Indicate course number and title)

Brief Project

Title for Transcript __________________________________________________________________

(Limit 25 characters including spaces)

Required Signatures

Student: Your signature below indicates that you are familiar with the independent study regulations

and that you have met with your advisor and the instructor to discuss the expectations of your project.

Student Signature: ______________________________________________ Date: ________

Instructor Signature _____________________________________________ Date: ________

Department Chair Signature ______________________________________ Date: ________

Advisor Signature _____________________________________________ Date: ________

____________________________________________________________________

FFICE

SE ONLY

# of Prev Indep Study ___ Dept/Nbr/Section: _____ - _____ - ____

Create course ______ Register _______

Revised 5/8/09

Form 337-7204 - Independent Study Registration Form

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