GRADUATE
Independent Study Application Form
Student Name: _____________________________________ UTD ID#: _________________________________
Current Degree: _____________________ Number of pass/fail cr. hours completed so far ________________
Briefly describe the goal of the proposed project (nature of research, example of readings, etc.)
What will be the final product of the independent study (paper, project, etc.)?
______________________________________________________________________________________________
How many credit hours will be assigned to this course? ________
Is this course pass/fail or graded? _______
When will the course take place?
Semester: _________ Year: ______
Full-Term
First Half
Second Half
The independent study will be set up under (check one):
ACCT BPS
MKT
IMS
MECO
OPRE
MIS
FIN
OB
HMGT
ENTP
MAS
Is the faculty sponsor full-time? Yes No (If not full-time, independent study will not be approved.)
Name of faculty sponsor_________________________________________________ Date______________________
(printed)
Signature of faculty sponsor ________________________________________________________________________
(indicating approval)
Signature of student: ______________________________________________________________________________
By signing, I agree to register in this independent study. I understand it is my responsibility to withdraw from courses for which I am registered and
do not attend, and it is my responsibility to read and understand the deadlines for refunds and for dropping classes according to the Academic
Calendar. I further understand and agree that payment for tuition and fees is due by the published date in the Academic Calendar to avoid
cancellation of my classes. I also understand that any refund will be based on the refund schedule set forth in section 54.006 of the Texas Education
Code published in the UTD Catalog. Please Note: All withdrawals are subject to the rules and deadlines in the Academic Calendar.
Course Prefix/Number/Section __________________________________
Last updated 10/6/15
Call # __________________ Advisor Processing Request:____________