APPLICATION FOR UNDERGRADUATE/GRADUATE

INDEPENDENT STUDY COURSES

Independent Study provides an opportunity for the student to pursue in-depth study of a topic of special value or interest to
the student related to the students major or the Honors Program.. The proposal and this application form must be submitted
first to the faculty /instructor, then to the advisor, then to the department chairperson for recommendation, and finally to the
appropriate dean for final approval.

GUIDELINES
An independent study program within a department must be listed in the University catalog with an accompanying
course description or must have received approval for inclusion in the catalog.
Prior to the granting of academic credit, the department shall approve the course of study undertaken by the
student.
The offering of independent study courses by the department shall be governed by the same credit hour constraints
consistent with University policy.
Print Name:

Student ID Number

First

Middle

Last

Official Approved Catalog Title ______________________________________

*Semester Course Topic:
NUMBER OF CREDITS **
*(along with catalog course title this will be included on academic transcript)
** Enter number of credits to be scheduled in the box above.
Check the schedule book for the credit range of the course.
Dept Name
Course #
Section #
CHECK ONE
Spring Semester
Summer Session
Fall Semester
Winter Semester

YEAR
20
20
20
20

Todays Date: ____________________________

Enter Summer Session

I agree to assume responsibility for instruction and awarding a grade at the conclusion of the semester or session.
The students proposal, as approved by me, is attached hereto.
SIGNED:
Instructor
DATE:
Print Instructors Name

APPROVED:
Advisors Signature

Date

Print Advisor
APPROVED:
Department Chairperson

Date

Print Department Chairperson

APPROVED:
College Dean

Print College Dean

Date

APPLICATION FOR UNDERGRADUATE/GRADUATE

INDEPENDENT STUDY COURSES
DEADLINES:

Summer:
Fall:
Spring:

Last Day of classes in spring semester

Last Day of classes in spring semester (decisions made late summer)
Day before Thanksgiving break
STUDENT GUIDELINES FOR INDEPENDENT STUDY
(Attach additional sheets if necessary)

1.

Description of the Proposal (i.e. what)

2.

Consent/approval necessary to conduct project rationale or relevance to the major (i.e. why)

3.

Objectives for the project (i.e. how)

4.

Your role

5.

Role of leader/manager/teacher

6.

Evaluation of independent study

7.

Bibliography (as applicable)

Student ID _____________________________ Student Name (Printed)___________________________________

Student Signature ____________________________________________ Date______________________________

Office of the Registrar, Bloomsburg University, Bloomsburg, PA

RO 511 11.2007