APPLICATION FOR INDEPENDENT STUDY (BIOLOGY 497) ROUTING FORM
To be filled out by student:
Student’s Name:
Local and Home Address(es):
Tel. Nos.:
E-mail address:
Major / Degree:
Credits sought (usually two or four):
GPA of courses in the Math/Science Division, as well as CS/Engineering taken at Binghamton ______
GPA of courses in the same category taken at other institutions
______
List maximum of three Biology faculty members with whom you want to work. Give names in order of
preference, #1 for most preferred. If no preference, mark with x in square to show there is no order of
preference 
Checklist of Materials included:
Routing sheet – one for office, one for student, and one for each faculty member listed
Application packet (s): one packet per faculty member listed. Each packet must include cover letter,
resume, sealed official transcript of Binghamton records, photocopies of records from other institutions.
To be filled out by faculty member:
Faculty Member’s Decision: [It would help students greatly if faculty members provide a decision by preregistration, final exam week, or regular registration, whichever date is closest and convenient, and let the
student know by e-mail. After signing, please return to the Biology Department Office. If you are not
admitting the student, please return the student’s entire application packet as well. ]
______ Offer made and student accepted
______ Would like to make offer, but Math/Science GPA below 3.0; justification provided below
_______Notified student that he/she cannot be admitted
_______Encouraged student to apply at a later term, with suggestions
____________________________________Date ________
[Faculty member signature]
Justification if you wish to admit a student with a Math/Science GPA below 3.0:
Departmental Approval (if Math/Science GPA below 3.0): ________________________Date ______
Final Outcome: ______ Registered _______________________ Term, A.Y.
_______ Not registered