1
UNDERGRADUATE or GRADUATE
INDIVIDUAL INSTRUCTION REQUEST / INDEPENDENT STUDY PROPOSAL
(see separate page of instructions)
STUDENT’S NAME _________________________________ STUDENT’S ID # F00 ___ ___ ___ ___ ___ ___
STUDENT’S MAJOR/PROGRAM _________________________ STUDENT’S TELEPHONE # _____________________
STUDENT’S EMAIL ADDRESS ________________________________________
SCHOOL YEAR: 20 ___ ___ – 20 ___ ___ (Check one) FALL __ WINTERIM __ SPRING __ SUMMER __
START DATE ____________________ ANTICIPATED COMPLETION DATE ______________________________
1. Title of Proposal (course and number), Credits Requested, & Type of Course
Course Prefix ____________ Course Number ______________________ (for existing courses only)
3