Submitted Wednesday, May 31, 2023 

Important: Please read the information below before completing the form.

Independent study in a course will be granted only in the most extraordinary circumstances. Eligibility for an independent study course will be determined by a committee comprised of academic department chairs, academic advisors and academic support staff or by the undergraduate or graduate advisor for students in majors on university approved teach-out plans.

If the committee or advisor determines that a student is eligible for an independent study course, the appropriate department chair will assign a professor and the student will be registered for the course by the Office of Registration and Records.

The assigned professor will organize all course requirements including exams, homework, lab assignments and research papers to compensate for the absence of classroom participation.

First Name:

Last Name:

Student ID:

Email Address:

Desired Term of Study:

Year:

Course number:

Course Title:

Number of Credits:

Reason for requesting independent study in the above noted course:

I understand that I am responsible for payment of tuition for the course I have listed above on the due dates listed in the schedule. Payments received after the due date/dates are subject to a late charge of $25.00. Initial here:

I understand that nonattendance of courses does not necessarily relieve students of their financial obligation. All requests to drop a class or withdraw must be submitted in writing to the Office of the Registrar in a timely manner. Initial here:

I understand that collection or litigation expenses associated with this account are the responsibility of the student. The university reserves the right to withhold all services with outstanding accounts. Initial here: