Request fo
or Graduatte Indepen
ndent Study
y Form
Complete
e all informattion on this fo
orm and subm
mit two weekks prior to beeginning of seemester. Student N
Name: Student IID #: College: Overall G
GPA: Semesterr/Year: Instructo
or ID #: Credit Ho
ours: (P/F only)
Major: VT Email A
Address: Departme
ent: Instructorr Name: Date Request Submittted: Title of Prroposed Inde
ependent Study: (Limit to 30 characterrs) Give a briief descriptio
on of the stud
dy and objectives. Give m
methods, justification, and method of evaluation. Attach ad
dditional information as needed. Student Date
Instruuctor Daate Advisor Date Depaartment Head//Director Deann Datte Daate Note: If aadding this co
ourse puts you
u over 18 credit hours, yo u will need permission forr an overload from the Gradu
uate School.