Independent Study Application
Please read the Independent Study Guidelines - http://svvsd.org/files/Independent-Study-Guidelines.docx - before filling out this application. These instructions are also located under "Professional Development Models" on the Professional Development website, www.stvrainopd.org.

• This application must be submitted to the Office of Professional Development for written approval a minimum of 3 weeks prior to the first session. This time frame will allow for modification, if needed.
• The application must be aligned with both district and school improvement goals.

Independent Study Title *
Your answer
Participant Name *
Your answer
E-Mail *
Your answer
School or District Department *
Your answer
Beginning Date *
MM
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DD
/
YYYY
Ending Date *
MM
/
DD
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YYYY
Independent Study Professional Development Credit and Participant Fees *
Choose semester hours/class fees from the list below.
Type of Credit - Licensed Staff *
The credit choices below are for licensed staff only.
Type of Independent Study (Select One) *
Data/Background Information
Explain what you will be doing for this Independent Study. *
Your answer
What data/background information did you use to determine the need for this Independent Study? *
Your answer
How did this information help you determine the focus of your Independent Study? *
Your answer
How will this independent study result in improved professional practice and/or increased student learning? *
Your answer
List the school/personal goals this project will address. *
Your answer
Summary Product *
Describe the concrete product that you will submit at the end of this project. Be sure the summary product aligns with your data and goals.
Your answer
Collaboration
Collaboration with Building and District Contacts *
List the appropriate building and/or district personnel that you have informed of this project. Be sure to include your building principal as one of your contacts.
Your answer
Collaboration with colleagues *
An Independent Study requires some collaboration in both its design and implementation. Ideally, provision should be made to disseminate the information to colleagues. How will you ensure collaboration in this study?
Your answer
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