PUBLIC
INDEPENDENT
PROGRAM CHANGE REQUEST FOR STAFF REVIEW
Title or CIP change only
Combination program created out of closely allied existing programs
Option(s) added to existing program(s) *attach copy of “before and after” curriculum, plus any existing and proposed options
Addition of certificate program developed from approved existing parent degree
Addition of free-standing single-semester certificate program
Before the Proposed Change
After the Proposed Change
Title of Old
Program/Certificate
Degree CIP Code
Title of New
Program/Certificate
Degree CIP Code
Delete program(s)
Delete options
Program placed on “Inactive Status” list
Program/Certificate/Option
Degree and CIP Code
Intended Date of Deletion/Inactivation
MM/YY
Change of address:
Closed location:
List sites where changes on this form should be applied (such as main campus, all off-site locations, etc.)
Name/Title of Institutional Officer Signature Date
Institution
____________________________________________________________________________________
9/2017
