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IMPORTANT: By submitting this form to the DAA the instructor is certifying that the students below are aware of the course requirements and agree to them.

Use this form to obtain approval for 294, 296, 494 and 496 independent study or research classes. Please complete all portions of this form, following the directions below, to submit a course for approval to the DAA.

Instructions to the Faculty: Complete the rest of the form, filling in all fields, and being sure to use the full email addresses (john_doe@psu.edu), then click the submit button. After clicking the submit button, you will be shown a copy of what you submitted. Remember to print or save a copy of this receipt for your records.


Campus Information


Semester of Delivery:

Course Abbreviation and Number:(e.g.,IST 296)

Number of Credits:

Course Title: (18 chars. maximum including spaces) e.g.(LIT Western Pa)

Brief Course Description: (20 words maximum) e.g.(LIT Western Pa)

Instructor Name

Student Information:

Student(s) Name(s)
Course Information:  
Course Description (Approximately 200 Words)  

Course Requirements and Grading Description:  



Please copy and paste this statement or insert your own into the field below.

Academic Integrity:  All students are expected to act with civility, personal integrity; respect other students' dignity, rights and property; and help create and maintain an environment in which all can succeed through the fruits of their own efforts.  An environment of academic integrity is requisite to respect for self and others and a civil community.Academic Integrity includes a commitment to not engage in or tolerate acts of falsification, misrepresentation or deception.  Such acts of dishonesty include cheating or copying, plagiarizing, submitting another persons' work as one's own, using Internet sources without citation, fabricating field data or citations, "ghosting" (taking or having another student take an exam), stealing examinations, tampering with the academic work of another student, facilitating other students' acts of academic dishonesty, etc. Students charged with a breach of academic integrity will receive due process and, if the charge is found valid, academic sanctions may range, depending on the severity of the offense, from F for the assignment to F for the course. The University's statement on academic integrity, from which the above statement is drawn, is available at http://www.psu.edu/dept/oue/aappm/G-9.html.

Insert Integrity



Please copy and paste this statement or inset your own into the field below.

The Pennsylvania State University is committed to providing access to a quality education for all students. Penn State welcomes students with disabilities into the University's educational programs. If a student has a disability-related need for modifications or reasonable accommodations in this course, it is the responsibility of the student to first obtain a University accommodation letter confirming the disability and suggesting appropriate remedies. This letter should be obtained from the campus Disability Contact Liaison. The contact person at Penn State Greater Allegheny is Siobhan Brooks (1st floor of the Kelly Library, 412-675-9454, snb16@psu.edu). It is encouraged that students request their accommodation need early in the semester (within the first two weeks of class), and once identified, a reasonable accommodation will be implemented in a timely manner. Students may also access the web site for the Office of Disability Services at University Park for more information: http://www.equity.psu.edu/ods/  

Insert Disability

Type in the corresponding emails


Course Instructor:




Independent Study Approval Form