Independent Study Or Mentored Research Enrollment Form
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1The College of New Jersey
Office of Records & Registration
P.O. Box 7718, Ewing, NJ 08628-0718
609-771-2141
INDEPENDENT STUDY OR MENTORED RESEARCH
ENROLLMENT FORM
ID #:
NAME:
___ ___ ___ ___ ___ ___
Last
First
M.I.
(6 digit PAWS ID)
PHONE:
EMAIL:
MAJOR:
ADDRESS:
Street
City
State
Zip
This Independent Study Enrollment form must be submitted to the Office of Records and Registration at the time of
registration. Registration will not be permitted if the form is incomplete or signatures are missing.
Do not use this form to establish a course to be taught on TBA basis. Independent study is not to be substituted for
a regular course.
SEMESTER: Fall ____ Spring ____ Summer ____ Year: _________
COURSE ID: __________________ SECTION ID: ______________ (for Records & Registration only)
INSTRUCTOR: ________________________
DEPARTMENT___________________
NUMBER OF UNITS*: ______ (Undergraduate – not to exceed 1.5 Units) (Graduate – not to exceed 9 credits)
GPA: ________ (Undergraduate – must be 2.5 or greater, Graduate – 3.0 or greater)
UNDERGRADUATE ONLY: TOTAL EARNED COURSE UNITS: ________ (Undergraduate -- must have completed at
least 14 Units – At least 3.75 units must be from TCNJ)
INDEPENDENT STUDY SUMMARY PROPOSAL: (Full proposal documenting course of study must be filed
with the Instructor only)
Independent Study Counts as: ____In-major Requirement for ______________________ requirement
____General Education for _________________________ requirement
____ Elective Credit
Please sign and date where indicated. All signatures must be completed before registration will be processed:
STUDENT: ____________________________________________________
DATE: ____________
*By signing this form, I acknowledge that I am responsible for the payment of all tuition and fees associated with the number of units
earned from this course.
INSTRUCTOR: _________________________________________________
DATE: ____________
DEPARTMENT CHAIR (or Designee): ______________________________
DATE: ____________
DEAN (or Designee): ____________________________________________
DATE: ____________
Revised 11/14
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