HSIP 499 - Independent Study Proposal Form

HSIP 499 - INDEPENDENT STUDY POLICY

1. Students may take independent study courses as an elective during their degree program. For students who have waived out of several required courses but need to meet the minimum residency requirement, up to one half of courses taken during full-time residency may consist of graded HSIP 499.
• The Student must identify a faculty member who is willing to sponsor and oversee the independent study course.
• The faculty member who agrees to sponsor the independent study course is expected to meet with the student several times during the quarter, provide guidance for the student's independent work, evaluate the student's work, and assign a grade. The faculty member is not expected to meet with the student every week.

2. The student should develop the structure and content of the independent study course under the direction of the sponsoring faculty member. An independent study course must be comparable to other graduate courses:
• A typical 1.0-credit course involves 30 hours of class time plus approximately 60-90 hours of homework.
• A 0.5-credit course will require approximately half that time.

3. If the independent study course involves attending a workshop or online course, the student MUST cover the cost of the workshop or course.

4. An independent study course must be approved by the Director or Associate Director of HSIP. An Independent Study Request Form must be completed and should be submitted at least four (4) weeks before the start of the quarter. Refer to TGS Academic Calendar for quarter start dates:
https://www.registrar.northwestern.edu/calendars/academic-calendars/index.html#TGS%20(PhD%20and%20Master's%20Programs)

Name Name First Last
NU Email (i.e. @northwestern.edu handle)
Date Requested
Note: Must be at least four (4) weeks before the start of the quarter. Date Requested
Note: Must be at least four (4) weeks before the start of the quarter. / MM / DD YYYY
Quarter and Year of Independent Study (Ex. Spring 2025)
Faculty Member Name
Faculty Member E-mail Address
Provide a brief summary of the topics that the independent study will cover, including their relevance and importance to conducting health services and outcomes research.

The independent study will provide the student with an opportunity to learn and practice:
The purpose of the course is to provide hands-on exposure to:
The following topics will be included:
State the specific learning objectives. At the end of this course, the student will be able to:
Describe the instructor’s role and responsibilities in the independent study.
The instructor will:
Describe the work plan and schedule. Include the frequency and duration of face-to-face contact with the instructor. Describe the work plan and schedule. Include the frequency and duration of face-to-face contact with the instructor.
For the duration of the 10 week course, the student will be expected to:
Specify the total hours of effort by major task (e.g., 20 hours conducting a literature review, 15 hours taking an online course, 5 hours of discussion with faculty, 20 hours analyzing secondary data, 40 hours developing a manuscript).
Describe specifically how the instructor will evaluate the student’s performance.
The student’s performance will be based on:
Depending on the nature of the independent study, it will be necessary for the student and faculty member to verify that IRB approval has been obtained if there are human subjects involved (refer to the Office for the Protection of Research Subjects) and provide proper documentation.

Does this independent study involve human subjects? If YES, provide a brief explanation and attach proper documentation of IRB approval.
This request form MUST be approved by the student and instructor. Applications without Instructor approval and Student's Signature will be returned without review.

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