GRADUATE APPLICATION FOR RESEARCH OR INDEPENDENT STUDY (596/599) 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:_________________________________Proposed date of Graduation:_________________________ Major:____________________________________________ Minor:___________________________________________ 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:__________________ Description of Proposed Study:__________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ Description of materials, resources, and methods to be employed:______________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ Brief Syllabus: ______________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ Method of Evaluation (to be completed by Faculty Supervisor):_______________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ Conference Dates (if appropriate) 1.________________2._______________3.________________4.__________________ Approved:__________ Denied:____________ ______________________________________________________________________ Faculty Supervisor (Please print and sign your name) Date Approved:__________ Denied:____________ ______________________________________________________________________ Department Chair/Graduate Program Director Approved:__________ Denied:____________ ______________________________________________________________________ Dean Date