Independent Study Course Request Form
Semester
*
Please Select
---
Summer
Year
*
Please Select
---
2022
2023
2024
First Name
*
Last Name
*
University of Arizona Email
*
You must share your University of Arizona email address (student@arizona.edu).
DNP Specialty
*
N/A
AGACNP
EHSL
FNP
NA
Nurse Midwifery
PNP
PMHNP
Specialty
For DNP/PhD students only. Please review the following, and check the box if the statement applies:
I am a Graduate Assistant (GA) or Teaching Assistant (TA) or Research Assistant (RA) during this term, and have filed the required paperwork to receive my benefits.
I am receiving QTR tuition benefits.
I am a recipient of the Graduate College's Dissertation Tuition Waiver (for non-WRGP out-of-state students), and have submitted by request to Graduate Student Services.
Course Number for Graduate Courses
*
Please Select
--Select a course
599=Independent Study
694=Practicum
699=Independent Study
791A=Research Preceptorship
799=Independent Study
920=Dissertation
922=DNP Project
Units
*
Faculty Name
*
Please Select
-- Select a faculty member --
Theresa Allison
Terry Badger
Carolina Baldwin
Courtney Bartlett
Aleeca Bell
Lindsay Bouchard
Brian Buchner
Heather Carlisle
Sheri Carson
Patricia Daly
Joe DeBoe
Sara Edmund
Nicolette Estrada
Charles “Reggie” Elam
Elise Erickson
Kristie Flamm
Rina Fox
Shawn Gallagher
Sheila Gephart
Judith Gordon
Timian Godfrey
Chris Herring
Janine Hinton
Kristie Hoch
Kathleen Insel
Maria Kenneally
Lisa Kiser
Cheri Lacasse
Amber Lindstrom-Mette
Sarah Locke
Julio Loya
Lori Martin-Plank
Erin McMahon
Ki Moore
Helena Morrison
Tarnia Newton
Tad Pace
Christy Pacheco
Juyoung Park
Gloanna Peek
Robin Poedel
Allen Prettyman
Jessica Rainbow
James Reed
Pamela Reed
Sally Reel
Cindy Rishel
Janet Rothers
Julienne Rutherford
Joan Shaver
Kim Shea
Graciela Silva
Meghan Skiba
Maribeth Slebodnik
Timothy Sowicz
John Sparks
Ruth Taylor-Piliae
Sarah Torabi
Jamie Velo
Deborah Williams
Shu-Fen Wung
Janay Young
Email
example@example.com
List the main objectives of this independent study:
*
List the desired outcomes of this independent study:
*
Faculty Member Approval
Approved
Not Approved
Reason for Denial
Submit
Should be Empty: