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					                                                  Department of Foreign Languages and Literatures
                                                  Virginia Polytechnic Institute and State University
                                                            Field Study and Senior Tutorial
                                                                 2964, 4964, and 4794

                         STUDENT INFORMATION                                                              COURSE INFORMATION

1) Name:      ,                                                                   1) Department:              ,
2) Student Number:                    ,                                           2) Course #:        ,           3) CRN #:          ,
3) Local Address:                 ,                                               4) P/F:      ,   A-F:             ,
4) Local Phone:           ,                                                       5) Term/Year:           ,
5) Major:     ,           6) College:                   ,                         6) Credit hours:            ,
7) Total Hours Passed:                    ,                                       7) Date request submitted:                     ,
                  1
8) Overall GPA :              ,       In-major GPA:         ,                     8) Instructor:      ,
10) Previously completed                        hours of 2964,                    9) Instructor's number:                ,
         hours of 4964,                       hours of 4794                       10) Title of Proposed Study (limit of 21 characters):
11) Hours of FS/ST this term:                       ,
12) Total hours this term:                    ,                                   11) Related courses already completed by student:
13) Use of this course for:
    Free Elective      , Other    ,                                               12) Does student satisfy departmental standards for
    Dept./College Elective     Required                          ,                   2964, 4964, or 4794?
    Minor
                                                                                                                   Yes       ,       No   ,

                  1
                      Student must meet the minimum GPA of his/her College and of the department offering the course for approval.


                                                            ATTACH DETAILED COURSE SYLLABUS
                       Give brief description of the study, objective, materials and methods, justification and method of evaluation.




             THIS FORM SERVES AS REGISTRATION FOR FS/ST 2964, 4964, AND 4794 COURSES IF PROPER APPROVALS
                     ARE OBTAINED AND IF THIS FORM IS PROCESSED BY THE STUDENT'S ACADEMIC DEAN.

 APPROVALS:             (Original to be forwarded to the student's Academic Dean's Office prior to the end of classes of the
                        preceding semester.)

                                                  Student                                                         Date

                                                  Advisor                                                         Date

                                              Instructor                                                          Date

                      Dept. Head of Instructor                                                                    Date

             Academic Dean of Instructor                                                                          Date

                  Academic Dean of Student                                                                        Date

				
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posted:11/22/2011
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