GRADUATE APPLICATION FOR RESEARCH OR INDEPENDENT STUDY (599/699) PRIOR to class reservation: Complete this form and obtain signatures of approval. Name:__________________________________________________________________________I.D.#_______________ Address:___________________________________________________________________________________________ Number and street city state zip Local Telephone No:_________________________________ Email Address:____________________________________
DEPARTMENT OR PROGRAM: _______________________________________________________________________ PROJECT TITLE:____________________________________________________________________________________ NUMBER OF UNITS (usually 1, 2, or 3 units):_____________________________________________________________ To be completed during (circle one):
Intersession
Spring
Summer
Fall
Year:__________________
Focus of Proposed Study:______________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ List of Activities:_____________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ __________________________________________________________________________________________________ Student Products to be Evaluated:_______________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________
Meeting Dates
1.________________
Approved:__________ Denied:____________ Approved:__________ Denied:____________ Approved:__________ Denied:____________
Revised 01/29/08
2._______________
3.________________
4.__________________
______________________________________________________________________ Faculty Supervisor (Please print and sign your name) Date ______________________________________________________________________ Department Chair/Graduate Program Director Date ______________________________________________________________________ Dean Date Registrar - White
n Advisor - Yellow
n Student - Pink