Contact Information:
If a mentee becomes ill and cannot work, they should contact:
Primary Person: email/SMS/Phone:
Secondary Person:
In case of an accident or sudden illness while working in the lab, the emergency contact information
for the student is:
Name:
Relationship:
Contact information:
Independent Study Agreement Form
Genetics Department
Student ID#:
Student Information
Name:
Majors:
Email:
Independent Study Major Professor and Mentor Information:
Name of Major Professor:
Name of Mentor:
Independent Study Course Number (check one)
299 = Freshmen & Sophomores 699 = Juniors & Seniors
Student is authorized to enroll in:
Semester: Year: # Credits *:
email/SMS/Phone:
To register for 299 or 699 independent study, Genetics undergraduate students must meet with their major research
professor and primary mentor (if someone other than professor) prior to, or at the beginning of each term to establish
or revise an independent study agreement that defines common goals and expectations for their research project.
Note:
- Use Adobe Acrobat to complete this form and have the signatures completed by hand.
- Incomplete forms will not be processed
- Forms should be completed and turned in before the add deadline each semester.
*3-5 hrs of work/week over a 15 week semester is considered equivalent to 1 credit. Additional guidelines and
information of campus polices regarding independent study can be found at:
https://kb.wisc.edu/vesta/page.php?id=36263
(Please complete page 2 as well)
choose
