Application to Add or Change an Academic Program
Office of Graduate Studies
California State University, Chico
Chico, CA 95929-0875
Effective Term: Spring 20 Or Fall 20 Chico State ID Number
Last Name First Name Middle Name
Mailing Address
( ) ( ) ( )
Home Phone Work Phone Cell Phone
E-mail: Birth Date:
Month / Day / Year
Check Applicable Action:
I would like to ADD the following NEW Academic Objective:
(Please specify NEW Master Degree Program, Option or Emphasis. Or specify NEW Credential or Certificate program.)
I would like to DROP my current program and CHANGE to the following Academic Objective:
(Please specify NEW Master Degree Program, Option or Emphasis. Or specify NEW Credential or Certificate program.)
Date Degree
(to be) Earned
List all institutions attended and location
since applying to CSU, Chico as a post-
Applicant's Signature ________________________________________________ Date
Bring completed form to the Office of Graduate Studies, Student Services Center #460 or mail to address above.
For office use only:
ADMIT as: Conditionally Classified or Classified, OR DENY
Please indicate if the GPA is equal to or greater than 2.5 or less than 2.5 cumulative in an acceptable baccalaureate program.
Graduate Coordinator’s Signature Date
3/3/2015
click to sign
signature
click to edit
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