Independent Study - Request For Approval - Brescia University College

Date of Request*

Name of Supervising Faculty Member *(If known)

Name of Student*

Student Email*

Student Number*

Course Number and Title*(If known)

Term*

Fall

Winter

Intersession/Summer

Credit Value*

0.5 credit

1.0 credit

Note to Faculty: Please submit the course outline to Marsha Lace by email at marsha.lace@uwo.ca

You will receive an email from Marsha Lace if approved. The Registrar's Office will enroll students once approved.

Please leave the rest of the form blank. The rest will be completed by the Provost.

Provost Approval

Approved

Not Approved

Reason

Date

Provost Signature