White: Records and Registration Yellow: Student Revised 11/19
Change of Major and/or
Declaration of Certificate
Please Print:
___________________________________________ _______________________________
Name CCM ID #
_______________________________________________
Phone
Request to Change Major:
From: ___________________________________________ To: ______________________________________
Current Major New Major
I intend to pursue the following Certificate of Achievement (s):
Certificate Program _________________________________________
Certificate Program __________________________________________
**Students are required to follow the degree requirements in effect at the time of matriculation, not those in effect at the time of
initial enrollment at CCM**
Did you attend another college? ( ) Yes ( ) No
**If yes, please list names of college(s) attended so we can re-evaluate your transfer credits**
Previous College(s) Attended:
_______________________________________________________________________________
_______________________________________________________________________________
__________________________________________________ __________________________
Student Signature Date
__________________________________________________ ___________________________
Advisor’s Signature Date
(Signature of advisor in new major is required)
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Records and Registration
Processed By __________________________________________ Date_______________________
