Independent Study Request Form printable pdf download

University of Illinois at Chicago

Independent Study Request

Jane Addams College of Social Work

Office of Academic Affairs & Student Services

Student (print clearly)____________________________________________

UIN: _______________________

Program:

MSW _____,

PhD _____

Semester and Year____________________________

Insert the call number of the appropriate independent study category (see the Jane

Addams Registration Packet for call numbers):

Practice, SocW 534, Call #_____

HBSW, SocW 549, Call #_____

Policy & Services, SocW 559, Call #_____ Research, SocW 569, Call# _____

Independent study requests are not approved until all approvals indicated below are

obtained. It is the student’s responsibility to seek all the necessary approval

signatures except the Associate Dean’s and then submit the form to the Office of

Academic Affairs room (4329 EPASW). If approval is given, staff in that office will

notify you to register. Read all the independent study criteria and policies on the

reverse side of the form before completing the form. Remember that MSW student

may apply a maximum of 3 credits of independent study toward the degree (more can

be taken, if approved, but only 3 will apply), and no more than 3 credits of

independent study can be taken in a given semester.

Title of independent study course: ________________________________________

Credit hours: 3, Contact hours per week: __________________________________

Course of study (attach additional sheets as needed):

a. Specific content of proposed course:

b. Approaches used in fulfilling course objectives:

c. Number and nature of written assignment(s):

10. Does the proposed course involve human subject research?

____No

____Yes (if yes is checked, complete the form on the reverse

side of this page)

11. Approval signatures:

Instructor: _________________________________Date: ____________

Advisor: __________________________________Date: ____________

Director of MSW Committee Chair (Practice, HBSE, Policy, or Research)

__________________________________________Date: ____________

Associate Dean: _____________________________Date: ___________

OVER

Independent Study Request Form