Student ID#: ___________________ Date of Birth: _________________ Phone: ________________________
Last Name: ___________________________ First Name: _______________________ Middle Initial: _______
Requirements for completion of Change of Program Request:
To complete this Change of Program Request, you must meet with an Academic Advisor to discuss educational goals and
potential changes to graduation requirements.
ere are additional requirements for certain students and programs:
• Students who receive financial aid and/or Veteran’s benefits should meet with Financial Aid and/or the Veteran’s
Officer to discuss any impact a change of program has on financial aid or payment.
• Students requesting to change to selective programs must follow the admissions process for that program.
Selective programs include: Dental Hygiene, Diagnostic Technician, Medical Assisting, Nursing, or Paramedic.
• International students with I-20 or F-1 Visas must meet with an Admissions Representative.
New Program of Study:
□ Associate in Arts (AA) □ Associate in Science (AS) □ Associate in Applied Science (AAS) □ Certificate (CT)
Program:________________________________________ Concentration: ______________________________________
□ I wish to REMAIN in my existing Advising Institutional Requirement Year (may not apply to newer programs) of: _________
□ I wish to CHANGE my existing Advising Institutional Requirement Year to the current academic year of: __________
Student Acknowledgement of Understanding:
I understand that changing my program and/or Advising Institutional Requirement Year may result in changes to my
graduation requirements, MASS Transfer eligibility, and/or Financial Aid or Veteran’s benefits as applicable.
udent Signature (required): _______________________________________________________ Date: ______________
fice of the Registrar Use Only:
Expected Grad Year Term ________ /________ Academic Planning Start Year Term ________ /________
Academic Advisor Use Only:
Does the student have any outstanding CLEP, Course Challenge, Substitutions, Transfer Credit, or need re-evaluation of
current transfer credits to be evaluated?
□ No □ Yes If yes, note details:
Advisor Signature: ____________________________________________________________ Date: _________________
Advisor Name: ___________________________________________________________ Extension: _________________
Office of the Registrar – CHANGE OF PROGRAM REQUEST FORM
2240 Iyannough Road │ West Barnstable, MA 02668
774.330.4711 │ Fax: 508.375.4084 │ email@example.com │ www.capecod.edu