REQUEST TO CHANGE PROGRAM

Student ID Number:

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Name *

Campus *

Exam Site:

Date of Birth

Telephone:

Email

Current Program:

Current Majors:

Major 1:

Major 2:

Current Minors:

Minor 1:

Minor 2:

New Program:

New Majors:

Major 1

Major 2

Minor 1

Minor 2

If sponsored, written approval from Sponsor must be attached to this form before change can be approved

I take full responsibility for the consequences of changing my program and agree to be bound by the regulations of the new program

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Signature

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Date