4g Readings/independent Study Registration Form printable pdf download

READINGS/INDEPENDENT STUDY REGISTRATION FORM

GRADUATE STUDENTS ONLY

Office of the Registrar

INSTRUCTIONS: This form is due back to the Registrar by the Add Deadline printed in the Academic

Calendar. Please make a photocopy for your own records. Please allow 7-10 days for processing.

GRADUATE STUDENT: Fill in Part 1. Have the instructor who will work with you complete Part 2. Your

thesis or research advisor must complete Part 3 and the department’s Graduate Program Director must sign Part

4. After obtaining the necessary signature submit this form to the Registrar’s Office by the Add Deadline.

INSTRUCTOR: If you agree to work with the student on an Independent Study course, complete Part 2.

THESIS or RESEARCH ADVISOR: After signing and dating Part 3 return this form to the student.

GRADUATE PROGRAM DIRECTOR: Please sign and date Part 4 and return this form to the student who

will submit it to the Registrar’s Office.

PART 1: (To be completed by the Student)

Date: _____________________

Rensselaer

Name: ___________________________________________________

ID #: ____-____-____

(LAST)

(FIRST)

(MI)

E-mail: ___________________________________________________ Day phone: _____________________

Term/Year: Fall _____ Spring _____

Summer _____ Session 1___ Session 2___ Session 3___

OFFICE USE ONLY

Subject Code (e.g. CIVL, MATH):

|___|___|___|___|

CRN#: ___ ___ ___ ___ ___

Course Number:

|_6|_9_|_4_|_0_| or |_4|_9_|_4_|_0_|

(Circle One)

(MAXIMUM

CHARACTERS

Course Title: _____________________________________________________

INCLUDING SPACES AND

PUNCTUATION)

Number of Credit hours for this independent study_________

Part 2: (To be completed by the Instructor)

Print Instructor's Name: ________________________________________________________________

(Last name, first, initial)

Instructor's Signature: ____________________________________________ Date: _____ /_____ /_____

Part 3: (To be completed by the student’s advisor)

Print Thesis/Research Advisor Name:__________________________________________

(Last name, first, initial)

Thesis/Research Advisor Signature:________________________________________Date: ___/____/____

Part 4: (To be completed by the student Graduate Program Director)

Print Graduate Program Director Name:______________________________________

(Last name, first, initial)

Graduate Program Director Signature:______________________________________Date:___/____/____

4g Readings/independent Study Registration Form

Related Articles

Related forms

Related Categories