Buffalo State – State University of New York

Individual Graduate Study Application

Directions:

Student to complete Parts A and B.

Confirm eligibility with advisor and obtain signatures of Instructor and Chairperson (Part C).

Return the completed and approved application and paragraph description to the appropriate School Dean of registered course by the Individual Study Application deadline. See academic calendar:

http://suny.buffalostate.edu/academic-calendar. Retain a copy for your records.

Payment: If registration for course occurs after deadline and is not included on your bill, contact Student Accounts for payment information. Failure to do so may result in late fees being assessed.

Part A:

Semester/year:	Fall	J-term	Spring	Summer ES, LS, VS (circle session)	20	Major:
Name:	Banner:
Last	First	Middle
Local Address:
Street	City	State	Zip
Phone Number:	Email Address:
Student Signature:	Date:

Part B:

Independent Study*	590
*see below	Department Prefix	Credit Hours	Course Title
MODALITY:	Hybrid	Hybrid-Plus	Online Asynchronous	Online Synchronous	Traditional
Master’s Project*	690
*see below	Department Prefix	Credit Hours	Course Title
Master’s Thesis*	695 or 795
*see below	Department Prefix	(circle 695/795)	Credit Hours	Course Title
Course by Contract
Department Prefix	Catalog ###	Credit Hours	Course Title

*Student MUST attach a one-paragraph description of the proposed course including purpose, specific objectives, course outcomes (e.g. research paper) and how it will be evaluated.

Part C:

B
Instructor’s Name	Instructor’s Signature	Date	Inst. Banner #
Department Chair’s Name	Chair’s Signature	Date
Academic Dean’s Name	Dean’s Signature	Date