Independent Study Petition

MASTER OF ARTS

(see back of form for instructions)

Student's Name                                                                         Student ID:                  ___Term_____

Degree Program                                                                       Course Number: _______491______

                                                                                                                                                                                    (Registrar will assign)

Proposed Topic (give exact title):                                                                                                       

Bibliography and/or study plan:                                                                                                                       

Proposed means of evaluation:                                                                                                            

Signature of Student:                                                                            Date:                                      

Instructor's Approval:                                                                          Date:                                      

Advisor's Approval:                                                                             Date:                                      

Approval by M.A. Program Director:

                                                                                                            Date:                                      

Comments:                                                                                                                                         

Copies to:                                                                    by                                date                             

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Grade                           Date                            Instructor