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Student Name:_______________________ Student Number:________________
Term, Year:_______, ________ Registration Number:___________
Prerequisite or Co-Requisite Survey Course or Introductory Course:__________
Credit Statement:
For satisfactory completion of the agreement, I will receive ___ credits of Independent Study:
_______________, ____ 298. (Example: 3 credits of Independent Study: Biology, BI 298)
subject #
Project:
Describe the nature and the method of the independent study (research, survey, tutoring, etc.):
Evaluation:
I understand I will be evaluated during the course of the term and upon completion of the Independent Study project, according to the guidelines of the discipline approved by Lane Community College.
Student signature:___________________________ Date: ___________________
Instructor signature: _________________________ Date: ___________________
Division Chair signature: ______________________Date: ___________________
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