M and M Independent Study/Research Application

I have read and meet the required Independent Study/Research prerequisites.

Is your advisor aware of your intent to apply for an independent study credit

Please contact your advisor to ensure the independent study meets your degree plan requirements.

Academic Advisor

Academic Advisor's E-mail

Today's Date

MonthDayYear

Cell or WIU Phone

Area CodePhone Number

Student Name

First NameLast Name

E-mail

WIU ID #

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Year

Semester

Major/Concentration

Academic Standing

Year of Graduation

Semester of Graduation

Course

Supervising Instructor

First NameLast Name

Supervising Instructor E-mail

Please indicate which type of course permission you are seeking

Undergraduate Independent Study Courses

Graduate Research Courses

Briefly explain why you need to complete an independent study. (max 500 words)

Attach any additional documentation you feel is relevant. (PDF files only).

Upload a File

Describe in detail your proposal for the Independent Study/Research course. In your description be sure to include information pertaining to the content, scope and preocedures you will employ in carrying out your plan of study. (A brief separate proposal may be attached to this form as an aid in justifying your projected study. (max 500 words)

Explain how previous coursework will contribute to and be integrated into the proposed independent study.

List the courses in your major area/concentration that you will be concurrently enrolled in while completing Independent Study/Research course.

Have you enrolled in an Internship, Independent Study or Research course previously at WIU?

If yes, please list Instructor, semester, course # and a brief description of course content.