Instructions: Please complete all items and then PRINT this form (it is not an electronic form submission process). A syllabus and course description must accompany all forms. This form must contain all signatures.
Campus Information:| Campus: Brandywine | Semester of Delivery: | |
| Course Abbreviation:
|
Number of Credits: | |
| Course Number: | ||
| Course Title: | ||
| Instructor Name: | ||
| Student is taking course for Honors credit: Yes | No
(If yes, Honors Independent Study Form must be included.) |
||
Student Information:
| Student Name: | |
| Student Penn State ID : | |
| Email Address: | Phone: |
Course Information:
| Syllabus (including examination policy, basis of grade and academic integrity policy) must be attached; (required) |
| Course Description (approximately 200 words); attached (required) |
Signatures Required :
| Student: | Date: |
| Instructor: | Date: |
| Honors Adviser:
(Needed if student is taking as an Honors course) |
Date: |
| Adviser: | Date: |
| DAA: | Date: |
OFFICIAL USE ONLY
Instructor Compensation (to be completed by the DAA):
Not part of load, no extra compensation: (Entered as 2 in ARUAI)
Not part of load, extra compensation: (Entered as 3 in ARUAI)
(08/25/10)