| 1. | Name of Student: | |
| 2. | Semester: | |
| 3. | Year: | |
| 4. | Number of credit hours, student is registered for: | |
| 5. | Instructor: | |
| 6. | Is this independent study given in conjunction with a regular course? Yes No | |
| 7. | If yes, state title and course number: | |
| 8. | Brief outline of program: | |
| 9. | What has the student to do in order that the instructor will recommend n credits as countable for the MA degree. (n is at the instructor's discretion, however n cannot exceed the number of registered credits.) | |
| Instructor: | Date: | |
| Student: | Date: | |
| 1. | Name of Student: | |
| 2. | Semester: | |
| 3. | Year: | |
| 4. | Number of credit hours, student is registered for: | |
| 5. | Instructor: | |
| 6. | Is this independent study given in conjunction with a regular course? Yes No | |
| 7. | If yes, state title and course number: | |
| 8. | Grade assigned to student: | |
| 9. | Briefly comment on performance of student. | |
| 10. | Recommended number of n credit hours countable towards the MA-degree: (n is at the instructor's discretion, however n cannot exceed the number of registered credits.). | |
| Instructor: | Date: | |