Continued
Student contact information
PLEASE PRINT CLEARLY and COMPLETE ALL ITEMS
Last name _________________________________________ First name _________________________________ Middle name _________________________
Current Residence:
Address ______________________________________________ Apt _____________________ Phone (__________) _________________________
City ______________________________ State _______________ Zip _____________________
Cambridge College e-mail _________________________________________________________________________________________________________________
Dates
Eective date
of change (mm/dd/yy): ___________________________
Fall Spring Summer Year __________
New Program: Expected graduation date:
January June August Year __________
3. Get all signatures below
or attach printouts of emails indicating program change approval.
The Registrar's Ofce cannot accept forms without all signatures.
Program Chair
of NEW program _____________________________________________________________ Date ____________________________________________________
Academic Dean
of NEW program _____________________________________________________________ Date ____________________________________________________
Program Chair
of current program __________________________________________________________ Date ____________________________________________________
Academic Dean
of current program __________________________________________________________ Date ____________________________________________________
4. By signing, I acknowledge
that:
• I must meet the requirements of my new program current at the time of this program change (see current academic catalog).
• I have reviewed this program change with my academic advisor/seminar leader and the receiving program chair
and discussed the academic, program cost, nancial aid, and transfer credit implications.
rev. 4/15/20
Request for
Change of
Academic Program
1. Your degree program/major
ESE Licensure
MEPID no. _______________
NEW
__________________________________________________
Licensure? Yes No
Level ____________________
Current
__________________________________________________
Licensure? Yes No
Level ____________________
Same program: please update advising institutional requirement year to current
academic catalog
2. Fill in course plan on next page with your new academic advisor
Registrar's Oce
Cambridge College
500 Rutherford Avenue
Boston, MA 02129
Phone: 617.873.0101
Fax: 617.242.0026
registrar@cambridgecollege.edu
After completing form submit it to:
Registrar's Oce
Cambridge College
500 Rutherford Avenue
Boston, MA 02129
Or email to:
registrar@cambridgecollege.edu
Or fax to:
617.242.0026
Student Signature
on paper printout or electronic* _______________________________________
Date _____________________________________________________________
*Please see electronic signature options on the Registrar's web page
.
Student ID#________________________
Your Cambridge College Location
Boston
Lawrence
Springeld
Puerto Rico
Southern California
NEIB
Other_____________
click to sign
signature
click to edit
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