Fillable Hybrid Fully Online Fully Face-to-face REQUEST TO ADD (California State University, Dominguez Hills)

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Hybrid Fully Online Fully Face-to-face REQUEST TO ADD (California State University, Dominguez Hills)

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Office of Academic Programs • WH 440 • (310) 243-3308
REQUEST TO ADD SELF-SUPPORT OPTION TO AN EXISTING DEGREE PROGRAM
Rev. 5/2020 1
Proposer Name:
Email:
Date:
College:
Dept.:
Ext.:
Proposed Effective Term:
Full & Exact
Program Name:
Delivery Type:
Fully Face-to-face
Fully Online
Hybrid
% F
ace-to-face % Online
Complete and include the following information:
I. Information for Existing State-Side Program
Program Name:
Program Type:
Graduate
Undergraduate
Option/Concentration/Emphasis Certificate
Credential
Delivery Type:
Fully Face-to-face
Fully Online
Hybrid
% Face-to-f
ace
% Online
CIP Code:
CSU Degree Code:
Complete and include the following information for the proposed self-support version of the program as an
attachment:
II. Rationale
1.
Rationale for the new support mode.
2.
Evidence and confirmation the existing state-support offering is not being supplanted.
3.
Specification of the program’s qualification(s) to operate as a self-support special session (per EO
1099 Article 6).
III. Resources: Consult with the College of Extended & International Education regarding budget and
enrollment.
1.
Detailed cost-recovery budget specifying student fees per unit and total student cost to complete the
program using the Chancellor’s Office template found here
.
2. Anticipated enrollment.
3.
Campus commitment to provide adequate faculty resources.
Office of Academic Programs • WH 440 • (310) 243-3308
REQUEST TO ADD SELF-SUPPORT OPTION TO AN EXISTING DEGREE PROGRAM
Rev. 5/2020 2
4. Anticipated impact on the existing state-support program resources
IV. Implementation
1. Attach approved existing state-side assessment plan.
2. Provide a course offering plan for first 3 years of implementation using the following template.
3. Describe how accreditation requirements will be met, if applicable, and the anticipated date of accreditation
request (including the WASC Substantive Change process).
V. Impact Statements from College Dean and CEIE Dean (Reference the Dean’s Impact Statement checklist)
VI. Attach evidence of consultation with ALL affected departments.
VII. Curriculum Register Synopsis: Include rationale for self-support offering to be posted for campus-wide
sharing in the Curriculum Register.
Office of Academic Programs • WH 440 • (310) 243-3308
REQUEST TO ADD SELF-SUPPORT OPTION TO AN EXISTING DEGREE PROGRAM
Rev. 5/2020 3
Faculty Proposer (Print) Faculty Proposer Signature Date
Dept Chair/Prog. Coord. (Print) Dept Chair/Prog. Coord. Signature Date
Department Curriculum Chair/Designee (Print) Department Curriculum Chair/Designee Signature
Date
College Curr. Committee Chair/Designee (Print) College Curr. Committee Chair/Designee Signature
Date
Provost/Designee (Print) Provost/Designee Signature Date
President/Designee (Print) President/Designee Signature Date
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Hybrid Fully Online Fully Face-to-face REQUEST TO ADD (California State University, Dominguez Hills)

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Completed 18 August 2020

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