Registrar’s Office
303-273-3200
Colorado School of Mines


Independent Study Registration Form

Current Student

Level:
□ Undergraduate
Please Print Clearly
□ Graduate

□ Non-Degree
By signing below, the student demonstrates understanding that to receive academic credit for an Independent
Study the student is expected to invest approximately 25 contact hours plus 30 hours of independent work per
semester hour of credit. (See back of form for detailed hour rules.)

Additionally, the faculty certifies that an appropriate course syllabus has been developed for the course,
reviewed by the Department/Division and the student, and is available upon request from the department.

This form must be submitted no later than the Census Day (last day of registration). Once this form is
completed and signed, return it to the Registrar’s Office.

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GRADUATE STUDENTS ONLY:
Is this Independent Study equivalent to any existing course in the graduate-level curriculum?

No
[ ]



Yes
[ ]


If yes, which course? ________________________________________________________


Reason for Request: ________________________________________________________

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ALL STUDENTS MUST COMPLETE THE FOLLOWING:

Semester/Year:
___________________


(If Registering in Summer II, select the desired term length: _____ 6-week; or _____ 8-week

Course Number:
Subject Code (e.g., CSCI): __________ and Catalog number (e.g., 499, 599, etc.): ______________

Course
Title:
_____________________________________________

Instructor
Name
(Printed):
_____________________________________________

Student Name (Printed): _____________________________________________

Student
E-mail:
_____________________________________________

CWID
Number:
___________________

Credit
Hours:
_________


Student Signature: __________________________________________ Date: __________________

Instructor Signature: _________________________________________ Date: _________________

Department Head Signature: __________________________________ Date: __________________

Updated 2/16

Registrar’s Office
303-273-3200

Credit Hours
Instructor
Independent
Total Hours
Hours Per
Contact Hours
Work Hours
Week
1.0 25.0 30.0 55.0 3.7
2.0 50.0 60.0 110.0 7.3
3.0 75.0 90.0 165.0 11.0
4.0 100.0 120.0 220.0 14.7
5.0 125.0 150.0 275.0 18.3
6.0 150.0 180.0 330.0 22.0

Updated 2/16