Request for Post Baccalaureate / Graduate Change of Objective Form
SUBMISSION DEADLINES
2 weeks prior to 1
st
day of the semester
This form is to be used ONLY by currently enrolled post-baccalaureate or graduate students (graduate program, credential, certificate or
second baccalaureate program students) in good standing who wish to change their academic objective or their status within a program (3.0
GPA for MS/MA and 2.5 for credential/certificate).
Name______________________________ CSUDH Student ID _____________________ □ F1 Visa
Email Address: ___________________________ Phone Number _________________________________
I. Change of Objective (to be completed by student)
Complete this section and consult Program Coordinator about additional information you will need to submit.
1.
My current program is
Current GPA Expected Graduation Date
2.
□ I request to change my program to ____________________________________________________________________
OR
3.
□ I request to add the program noted below:
Program
Please Check: □ Credential □ Certificate
4. Effective Term: □ Spring _ □ Summer □ Fall
Year Year Year
Student Signature Date
II. Program Coordinator Recommendation, Please indicate academic code (When completed, return form to the Office of
Graduate Studies, Welch Hall
D445)
Academic Code: __________________________
1.
□ Deny request/ status change: Please state reason ___________________________________________________________________
2.
□ Approve request/ change status as shown above
□ with classified status
Program Option
□ With conditionally classified status. Be certain to inform the student of the conditions. If the student does not fulfill the conditions of
admission and continuation in the program, the coordinator may administratively disqualify the student from the program by sending
a memo to the Office of Graduate Studies.
Program Coordinator (Print)
Signature
Extension Date
FOR OFFICE USE ONLY: Change of status entered by:
(Form Rev.April 2019) Date Processed
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