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PROGRAM CHANGE FORM This form is to be (Fairleigh Dickinson University)

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PROGRAM CHANGE FORM
This form is to be completed by the student after consultation with his/her Program Coordinator and Academic Advisor. To change programs a student
must be in good academic standing and meet the admission requirements of the new program. A copy of this form must be returned to the Enrollment
Services Office after all approvals are obtained. The School/Department of the new program will prepare a revised curriculum check sheet. (Please be
certain that prerequisites for the new curriculum are satisfied.)
Last Name:__________________________________ First Name:___________________________ Student ID:______________________
E-mail:____________________________________
Home Phone: (____)_________________
Cell Phone: (___)________________
Change Requested: Program Change Change of Major Change of Concentration/Specialization
Academic Advisor:
Current: Program/Major/Specialization or
Concentration
Request to Change to:
Student’s Signature:
Date:
Transfer Credit Review Required (attach Course Mapping).
Undergraduates Only: I have earned between 16 and 64 credits, and am requesting my one time privilege of having the grades of D and F in the following courses, not
required in my new curriculum, be excluded in the calculation of my CGPR (To be approved by the Director/Chair of the new curriculum)
Course Title
Grade
Approved
Course Title
Grade
Approved
TO BE COMPLETED BY RECORDS OFFICE Date:______________________
CGPR
CUM. CREDITS
CHECKED BY:
APPROVAL SIGNATURES REQUIRED:
Advisor change required
YES NO
Current Advisor
Date
Old Major/Concentration
Program Coordinator
Date
Approved
Disapproved
New Major/Concentration
Program Coordinator
Date
Approved
Disapproved
Director of Enrollment Services
Date
Approved
Disapproved
Comments:
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
FDU V-Program Change Form- December 2015
Received by Enrollment Services
Date:
By:
Colleague Updated by
Date:
By:
New check sheet prepared
Date:
By:
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Completed 21 August 2020

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