Fillable Request for Change of Program Revised July 10, (Black Hawk College)

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Request for Change of Program Revised July 10, (Black Hawk College)

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File type: PDF

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Request for Change of Program Revised July 10, 2020
Student Name: _________________________________ BHC ID #:__________________________
Catalog year: ________________
AA – Associate in Arts Code: 1145
Concentration (What do you plan to study at your transfer institution?) ____________
AS – Associate in Science Code: 1645
Concentration (What do you plan to study at your transfer institution?) ____________
AAS – Associate in Applied Science _____________________________ Code: _________
Certificate ________________________________________________ Code: _________
See an Advisor before selecting one of the programs below:
AFA – Associate of Fine Arts (Code: 1245)
ALS – Associate in Liberal Studies (Code: 2031)
Departmental approval is required before selecting one of the Selective Admission programs below:
AAS – Associate Degree Nursing (Code: 5456)
AAS – Surgical Technology (Code: 5173)
AAS – Veterinary Technology (Code: 5017)
AAS – Physical Therapist Assistant (Code: 5179)
CERTIFICATE – Practical Nursing (Code: 5666)
Student Signature*______________________________________ Date: ______________________
Dept. Chair signature**___________________________________ Date: ______________________
*Signature may be left blank and e-signature will be accepted when completed form is sent from the
student’s myBlackHawk Email account.
**Only required for Selective Admissions programs. In lieu of Dept. Chair signature, a copy of program
acceptance letter may be attached.
Return by email to registrar@bhc.edu or deliver in person to Enrollment Services at either campus.
Office Use Only: ADD/REMOVE
Processed by: _____________ Date: __________ ADV Hold/Comment: ___________ Date: ___________
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Request for Change of Program Revised July 10, (Black Hawk College)

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Completed 15 September 2020

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