Department of Accounting

Request for Independent Study

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First name

 _____________

Middle name

 ___________________________

Last name
___________________

email (only _@uic.edu)

 _____________

Phone Number

 ___________________________

UIN #


Level Enrolled:
_________________

College

 Undergraduate


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Major / Program

 Graduate


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Current GPA

 Nondegree


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Expected graduation date


 Fall    Spring    Summer

 
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Year


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CRN



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Credit Hours

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Supervising Instructor's Name		 ___________________________
Signature
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Date


Reasons why you think you want to take this course:




Signature   __________________ Date______________

Department use only:Approved:
Department head's signature _________________ Date_____________