Authorization for Independent Study

Directions to student: A syllabus or contract between you and the instructor that describes the requirements of the course is required for independent study credit to be issued. We recommend having a copy of the syllabus or contract on hand to assist you in filling out this form. Once you have filled out the form, it will be forwarded to the instructor for approval.

Directions to Instructor: You must either approve or deny the student's request. If you approve, you must attach a copy of the syllabus or contract which describes the nature of the project/study and indicate the intended learning outcomes, evaluation procedures, and student requirements for the independent study. If this request is being made after the add/drop deadline (census date), you will also need to attach a reason for the late add. Once you approve, the documents will be forwarded to your department chair for approval. If the course is 500 level, the director of the Graduate School must give approval.

Once all approvals have been received the course will be created.

Name*

First NameLast Name

Student ID Number*

Your Email*

example@grizzlies.adams.edu

Are you currently an on-campus ASU student?*

If not, please see our Office of Admissions before submitting this completed form.

Semester*

Year*

Subject*

Ex: ENG, MATH, etc.

Course Number*

Course Title*

30 Character Limit

Semester Hours*

Grade Mode*

NormalPass/Fail

Reason for Independent Study *

Please ensure you enter the correct email addresses for the instructor and deparment chair (or grad school representative if the course is at the 500 level). If needed, you can search for staff email addresses using our online campus directory.

Instructor's Email Address*

example@adams.edu

Department Chair/Grad School Email Address *

example@adams.edu

Student Signature*

Campus

Approval Status

Instructor Signature

File Upload

Department Chair Signature