REGISTRAR

Application for Independent Study (Rostered Course)

Prior to completion of this form, students must have a conversation with their professor and academic advisor. Independent studies will be approved on a case by case basis dependent on when a student is planning to complete his/her program.

Name*

First Name

Last Name

Student ID

Your Student ID can be found at the top of your schedule on MyLBC

Date of Birth*

Semester of Independent Study:*

I am in the following program:*

Course Code and Title*

My reason for requesting an independent study is:*

Are you in your last two semesters at LBC?*

Yes No

How many other rostered courses have you taken as independent studies?*

The limit is a total of 2.

Professor's Name*

A syllabus will be necessary in order for the Registrar's Office to complete your independent study.

Academic Advisor/Program Coordinator's Name*

Have you spoken with your academic advisor or Program Coordinator about this independent study?*

Yes No

Your academic advisor or program coordinator's approval is required.

Have you spoken with your professor about this independent study?*

Yes No

Your academic advisor or program coordinator's approval is required.

Signature

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Use your mouse or finger to draw your signature above