Name________________________________________     Date____________
PID______________________     Major_________________     GPA________
Course:  FRN 492     LTN 499     Credits______     Semester________
(Circle appropriate course)
Brief Description of Proposal:
Estimated Contact Hours per week with Director______________
Deadline for submitting work for final evaluation______________
Student Signature______________________________________________
Student Email Address______________________   Telephone______________
Director’s Signature______________________________   Date____________
Advisor’s Signature_______________________________   Date____________
Associate Chair’s Signature_________________________   Date____________