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
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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.
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