Change of Graduate Program
Section 1: To be completed by the student
Louisiana College ID#________________________
_________________________________ _____________________________ __________
Last name First Name MI
______________________________ _______________________ _______ __________
Street Address City State Zip Code
___________________________ _______________________ _______________________
Date of Birth Email Phone number
Are you currently enrolled and registered? ________
To be completed by proposed graduate program
Transfer/Admission: ______Approved ______Denied
Courses counting toward degree: ______All _______None ________only those listed below
___________________________
___________________________
Expected Graduation___________
_______________________________________________
Signature, Dean/Program Director/Date
To be completed by the Graduate Council
Petition is: _____Approved _____Denied Date________________
Current Graduate Program Graduate Program Petitioning for Transfer
___________________________ __________________________________
Current Program Proposed Graduate Program
Degree Pursuing______________ Proposed Degree_____________________
Will student complete and graduate from Proposed semester of transfer___________
current program? _________
Proposed Graduation Date_____________
________________________________
Student Signature/Date
________________________________
Signature, Dean/Program Director of Current Program/Date
NO
NO
click to sign
signature
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