For students intending to engage in independent study, an internship, research, or serving as a teaching assistant. Note: This form should be completed by the supervising faculty member only. Supervising Faculty Information Supervising Faculty Name Penn State Email Student Information Student Name Penn State Email Penn State ID Your Penn State ID is a nine-digit number beginning with the number "9" found on your Penn State ID card. Please enter numbers only. No hyphens or spaces. Major Semester Standing Select One123456789+ Course Information Course Type Independent Study Internship Research Teaching Assistant Semester Fall Spring Summer Year Course Subject Example: ENGL, MATH, etc. Course Number: Independent Study 196 296 396 496 Course Number: Internships 195 295 395 495 Course Number: Research 294 394 494 Course Number: Teaching Assistant 395 Academic Division Arts and Humanities Business, Engineering, and Information Sciences and Technology Education, Human Development, and Social Sciences Mathematics and Natural Sciences Credits - Select -123456789101112 Beginning Date Ending Date Is this independent study research-related? Yes No Plan/Project Description or Outline CAPTCHA Submit
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