1 College Place, Claremont, NH 03743
with Academic Centers in Keene, NH & Lebanon, NH
www.rivervalley.edu 603-542-7744 rivervalley@ccsnh.edu
PROGRAM CHANGE OR ADD FORM
Students shall use this form to add or change their academic program. Student shall fill out form completely including obtaining
the necessary signatures before submitting this form to the Admissions Office: RVCCAdmissions@ccsnh.edu.
A __ __ __ __ __ __ __ __ _____________________, __________________ ______
Student ID# Last Name First Name MI
(Updated 2020-07-16)
Address: _____________________________________________________________________________
Street/PO Box, Apt # City State Zip Code
Email Address: ________________________________________________________________________
Cellphone #: __________________________ Home Phone # (if available): __________________________
I am currently enrolled in the following program(s) and would like to continue in or withdraw as indicated:
I request admission to the following program(s):
By my signature below, I understand that:
1. This request will be reviewed by the appropriate College officials; it is not a guarantee of acceptance.
2. I will not be withdrawn from a program until I am matriculated into another (above listed) program.
3. Courses previously taken at RVCC may not transfer to my new program.
4. Courses previously transferred to RVCC may not transfer to my new program.
Student Signature & Date: _______________________________________________________
Current Advisor Signature & Date: ________________________________________________
Additional Current Advisor Signature & Date: ______________________________________
(if applicable)
Future Advisor Signature & Date: _________________________________________________
(Signature of future advisor indicates acknowledgement of application and not acceptance)
Additional Future Advisor Signature & Date: ________________________________________
(if applicable) (Signature of future advisor indicates acknowledgement of application and not acceptance)
Please email this completely filled out and signed form to: RVCCAdmissions@ccsnh.edu
You may also fax it to: (603) 543-1844 or Mail it to: RVCC, Attn: Admissions Office, 1 College Place, Claremont, NH, 03743
Semester:
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