ITHACA COLLEGE School of Health Sciences and Human Performance Graduate Program Petition for Independent Study / Research / Readings (Note: this form must be filled in online) Course Information Department: please choose one Course: please choose one Number of Credits (check one): 1 Semester of Registration (check one): For office use only: CRN: 2 Fall 3 Spring Summer Winter Student Information Name: E-Mail: I.D. Number: Telephone (Local): Project Information Title of Research Project: Name of Faculty Sponsor: Planned Time Commitments (In the space below, please list the approximate number of hours that will be spent in each area. The total number of hours must sum to a minimum of 45 hours per credit) Reading: Research: Writing: Faculty Consultation: Exams: Lab: Other (please explain): Design Statement Students must complete a Design Statement along with this form. Please follow the format provided on the accompanying pages. The design statement must accompany this application when obtaining signatures. Signatures Once all signatures are obtained, the student will be registered in the course by the Dean’ office. Students may not register for the course until all signatures have been obtained. Student Date Faculty Sponsor Date Consultant (if any) Date Graduate Program Chair Date HSHP Deans Office Date Page 1 of 2 Required Components of the Design Statement for Independent Study / Research / Readings An independent study is based on a special arrangement between a student and a faculty sponsor. It allows specialized or individual kinds of study that may not be available in regular classroom or laboratory instruction. Regular courses listed in the Undergraduate Catalog may not be taken on an independent study basis for graduate credit. Eligible types of designs include categories such as independent study, directed study, advanced reading and independent research. The required design statement sets forth the specifics of the study arrangements as agreed to by the student and the faculty sponsor. The following component parts should be clearly stated: 1. Course number as listed in the Graduate Catalog, the title of the course, students name and ID number, semester and year of registration for the course. 2. Amount of credit. Independent research can be taken for 1 to 3 credits. The total amount of time a student should spend on activities directly involved in this study is determined based upon the formula that one credit hour represents 45 hours of student learning. 3. A description of the specific learning objectives. 4. A description of the student's preparation for undertaking the study (e.g. previous coursework, etc.). 5. Reading List. A suggested or partial list of material sufficient to provide focus and stimulate investigation in the topic. This list does not necessarily need to be complete. 6. A description of the forms and scope of the culminating activity of the research (e.g. written paper, final exam, presentation, film, etc.). 7. A description of the method and amount of on-going interaction with the faculty sponsor/consultant (e.g. meetings, periodic discussion of research, discussion of final product, methods of reporting progress, etc.). 8. A tentative time-line describing the weekly activities. 9. Grading scheme. State the criteria and procedures for evaluation and the weight given to various elements of the study. Indicate if the final grade will be pass/fail or a letter grade. 10. Consultants (if any). Where the research involves more than one faculty member, one faculty member should serve as the faculty sponsor and the others as consultants. The role and contribution of each consultant should be included, but the overall responsibility for overseeing the course remains solely with the faculty sponsor. Page 2 of 2