Declaration/Change of Minor
IMPORTANT:
• If you are declaring more than one minor you will need to submit separate forms for each request.
• If you are declaring a minor in Business please go to the Undergraduate Business Advising Center (UBAC), Tahoe Hall
Room 1030.
• If you are declaring a Special Minor please go to Academic Affairs, Sacramento Hall Room 234.
• Do NOT use this form if you have applied for graduation.
• Submit completed minor change form to the Student Services Counter, Lassen Hall Lobby.
_____________________________________________________________________________________________
PLEASE PRINT IN BLUE OR BLACK INK
Student ID#: _______________________________________
Name: _______________________________________________________________________________________
Last First MI
Day Phone: ___________________________________ Email: ______________________________________
Have you applied for Graduation? Yes □ No □
Have you ever been academically disqualified from the minor that you are now declaring? Yes □ No □
I am an undergraduate student and my immediate degree objective is BM □ BA □ BS □
I am a post-baccalaureate student and my immediate objective is 2nd Bachelors □
PLEASE INDICATE APPROPRIATE CHANGES:
Change Minor to: __________________________________ □ (by checking this box, your current minor will be deleted)
OR
Add Minor: _______________________________________ □ (please add this newly declared minor as an additional minor)
_____________________________________ _____________________________________ __________
ADVISOR’S NAME (PLEASE PRINT) ADVISOR’S SIGNATURE (REQUIRED) DATE
_____________________________________ _____________________________________ __________
DEPARTMENT CHAIR’S NAME (PLEASE PRINT) DEPARTMENT CHAIR’S SIGNATURE (REQUIRED) DATE
________________________________________ ____________
STUDENT’S SIGNATURE (REQUIRED) DATE
For Office Use Only
REV 02/13 Initials: ____________ Date Posted: ______________
