Contact Student Records at 828.448.6049 if you need an alternative method to complete this form
Office of Admissions and Records, 1001 Burkemont Ave., Morganton, NC 28655
Attn: Wesley Kaylor, or Cathy Williams,
Fax Number: (828) 448-6179
STUDENT NAME: ________________________________________________________________________
(Please print clearly as it now appears on your Records)
STUDENT ID #: ______________________________ DATE: ____________________________________
BIRTHDATE: ___________________________ CONTACT PHONE #: ____________________________
Program Changes will be processed at the end of the current term and will be effective prior to the
upcoming term.
Change Program to: __________________________________________________________________
(Must complete a new application if not enrolled for two consecutive semesters, does not include Summer semester)
(**Changing your program of study can affect Financial Aid eligibility. If you receive Financial Aid,
discuss your intended program change with the Financial Aid Office BEFORE you submit this form.)
______ Please check here: If you are graduating from WPCC at the end of this semester.
______ Please initial this section if you want to remain on the Allied Health List you are currently listed on.
______ RE-ACTIVATION (Allied Health Programs only): Must complete a new application if not
enrolled in the past Academic Year
(AAS-Registered Nursing program only) Re-entrance date/semester: ________________
Student Initials (required for changes to be processed):__________
Student Records Use Only
New Advisor: ______________________________________ Initials/Date Information Changed: ________________
Comments: ________________________________________________________________________________________