ࡱ > 3 5 2 p bjbjT~T~ 0 6 6 c 8 7 , c s . 7 7 7 C! x " - j j j j j j j j `i2"@ & p j C 0 s j ! ! j j ! ~ 7 K j Y e W 7 7 7 7 7 7 s ! 7 7 7 7 7 7 7 7 7 : * This application must be approved before the semester begins. It must be completed by the student with the department chair of the course and instructor and then delivered to the Office for Academic Affairs.
To the Instructor: If you are planning an Independent Study with a student, please call the Registrar to make sure the class is first added to the master listing of courses in the computer.
Print Name of Student For Semester ____________
Campus Mailbox # ______________ Instructor _______________
Cell Phone # ________________ Mailing Address ________________________________
Students Major _______________________________________________________________
Students GPA *A student must have a GPA of 2.5 or higher to be eligible.*
Title of Project _____________________________________________________________
Credit Hours
Attach Syllabus or write a Description of the Project (Include general topic and specific area(s) to be studied. Attach a separate sheet if necessary.)
Learning outcomes:
Attached Reading List related to the topic (please check when attached)
Methods of Assessment:
Signatures:
Department Chair _______________________________________ Date: ______________
Print Name: ____________________________________
Student ______________________________________________ Date: ______________
Instructor ____________________________________________ Date: ______________
Print Name: ___________________________________
Dean for Academic Affairs ______________________________ Date: ______________
cc: Registrar Department Head
Instructor Academic Advisor
Student
MITCHELL COLLEGE
Application for an Independent Study
PAGE
Revised: 6/2011
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