INDEPENDENT STUDY COURSE APPROVAL FORM
Student’s Name: ____________________________________________
Student’s Email: ____________________________________
Term and Year Requesting: ______________________
Penn ID#: ________________
Student’s School: __________________
Date: ____________________
Instructor: _____________________________________
Email: ______________________________
Telephone #: ___________________________________
Dept/Div: ____________________________
Course Number (check one): □ EDUC 999
or
□ EDUC 399 (undergrad only)
This form is only valid for independent study with GSE faculty. If independent study is with faculty
outside of GSE, then approval must be granted by the host school.
All Graduate School of Education students are eligible to enroll in independent study courses at GSE
rates, IF
1) The course does not duplicate a GSE course offered in the same semester
2) The student has completed an introductory course in the same field as the independent study, and
3) The division approves
The signature below certify that the conditions above have been met
_____________________________________________
Signature of Student
____________________
Date
_____________________________________________
Signature of Instructor
____________________
Date
_____________________________________________
Signature of Division Chair
____________________
Date
Return signed and completed form to: Penn GSE Student Records Office, 3700 Walnut Street, 2nd
Floor, Philadelphia, PA 19104
Last updated 9/2014