Form PC - Program Change

PROGRAM CHANGE FORM

1. Submitted by: _________________________________________

2. Type of Program Change (Check those that apply):

   _____ Title change only
   _____ Combination program created out of closely allied existing programs
   _____ Option(s) added to existing program(s)
   _____ Addition of single-semester certificate program (C0) to existing parent degree (@15CH)

_____ Addition of one-year certificate program (C1) developed from existing parent degree (@30-40CH)
   _____ Addition of free-standing single-semester certificate program
   _____ Delete program(s)
   _____ Delete option(s)
   _____ Program placed on "Inactive Status" list

_____ Other (attach description)

Current Program Program after the Proposed Change
Title Degree CIP Code Title Degree CIP Code
           

4. Attach a copy of the "before and after" curriculum, as applicable, and a rationale for the proposed change.

5. Intended date of program change, additional options, or "Inactive Status":

________________________________________________________
Month/Year

AUTHORIZATION

_______________________________________________________
Name/Title of Institutional Officer    Signature    Date

_______________________________________________________
Person to Contact for More Information     Telephone Number