AH-Certificate of Study Change Form FEB2019 final.docx/1
First Name Middle Initial Last Name Student ID #
Street Address City and State Zip Code
Phone Alternate Phone Date
Action:
(check one)
Add Change to
Certificate Name:
Certificate Name:
Certificate Name:
Certificate Name:
Certificate Name:
The catalog of record is the catalog that was in effect at the time you chose your program of study. You will follow the academic
requirements in this catalog for graduation purposes. If you are unsure of your catalog of record, please see your academic advisor.
Advisor Signature:
Date:
Advisor signature is required to change Catalog of Record
Educational Objective
Transferring to a four-year college
Improving skills for present job
For personal interest
Preparing for a future job
Preparing for GED
Unknown/Other
Student Signature: ____________________________________________________________
By signing this form, the student acknowledges the potential impact to Financial Aid and Graduation
This certificate change will be made effective for the current term until the midpoint of the semester. After the midpoint of the
semester, the certificate change will be effective the following semester. Please see the Enrollment Services Office if you have
questions regarding the affect this change may have on your financial aid disbursement.
If you are a current high school student, please indicate your graduation year: _______
Certificate of Study Change Request
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