Form PC

PROGRAM CHANGE FORM

1. Submitted by: _________________________________________
Name of Institution (Campus or off-campus residential center in the case of multi-campus institutions)

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 certificate program developed from approved existing parent degree
   _____ Addition of free-standing single-semester certificate program
   _____ Delete program(s)
   _____ Delete option(s)
   _____ Program placed on "Inactive Status" list

3. Indicate Program Change or Addition of Options:

Before the Proposed Change			After the Proposed Change
Title of Old Program or Certificate Option	Degree	CIP Code	Title of New Program or Certificate Option	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