I N D I V I D U A L ST U D I ES F O R M
T H A 4000 or D A N 4000
This form is to be completed, signed by the student and faculty supervisor, and given to the undergraduate
advisor. The original form will be kept on file and copies will be given to the student and faculty
supervisor.
**N O T E : T he student will not be able to register for the course until all paperwor k has been
completed and submitted to the undergraduate advisor.**
Course Number: TH A 4000._____ (____ credit hrs.)
(section)
DAN 4000._____ (____ credit hrs.)
T erm: Fall
Spring
Summer I
Summer II
Y ear: _______
(section)
Name:______________________________________________R#:___________________________
A ddress:__________________________________________________________________________
Phone Number :_________________________ E-M ail:___________________________________
F aculty Supervisor:_________________________________________________________________
Director or Production Supervisor (if applicable):________________________________________
T itle of project:____________________________________________________________________
B rief description of project:__________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
B rief description of evaluation method to be used in assigning grade:_______________________
__________________________________________________________________________________
__________________________________________________________________________________
Books or other references for which the student will be accountable:________________________
__________________________________________________________________________________
__________________________________________________________________________________
ST U D E N T SI G N A T U R E :____________________________________ D A T E :_______________
F A C U L T Y SI G N A T U R E :____________________________________ D A T E :_______________
***Please attach additional paperwork to this form.***
Revised 5/25/06