Independent Study Request Form (Page 2 of 2) in pdf

12. Human Subject Research

If “yes” has been checked on item 10:

The supervising faculty must have completed UIC IRB training, including the requirement for

continuing education.

I have completed UIC Investigator Training and I’m in compliance with

Investigator Continuing Education requirements ( I have a certification that is

current for the period of the proposed independent study):

_____________________________________________________

Supervising faculty signature/date

In addition, if the proposed independent study will result in a conference

presentation (or proposal for such presentation) or manuscript submission for

possible publication, IRB approval must be obtained before any data is gathered.

Will the proposed independent study result in a conference presentation proposal

or manuscript submittal for publication?

_____ Yes (provide information requested below)

_____ No

If the answer to 12.b. is yes, indicate whether IRB approval has been obtained or

give the timeline for seeking it (attach additional pages as needed).

__________________________________________________

Supervising faculty signature/date

Jane Addams College Criteria and Policy for All Independent Studies

MSW students may apply a maximum of 3 credits of independent study toward the degree. More

can be taken, if approved, buy only 3 will apply. Only 3 credits of independent study can be taken in

a given semester.

Focus of independent study must be topic area not offered in formal Jane Addams

College course.

Student activity is to build upon and extend knowledge in a specific curriculum area

(HBSE, practice, policy and research).

There is to be an approximate equivalence between amount of work and number of

hours of independent study on the one hand and a formal other course on the other

hand.

Student must produce scholarly written products for purposes of grading; an annotated

bibliography itself is not sufficient scholarly writing.

Not more than 3 credits of independent study can be taken in term. No more than 3

credits can be applied toward the MSW degree though PhD students may exceed these

limits if other processes are followed.

Student is to submit a written independent study proposal describing scope and depth

(see reverse side of this form) by the fifth day of the semester. Proposal must specific

course content, approaches used to fulfill course objectives, extent and nature of written

assignment (s), and number of contact hours with faculty.

Sponsoring faculty member assumes responsibilities for above criteria being met.

Independent study credits may not be given for courses, workshops, institutes, etc. taken

in our outside Jane Addams College.

Independent Study Request Form Page 2