_______ ____________
Pronouns (Optional)
UNDERGRADUATE CHANGE OF MAJOR, SECOND M AJOR, MINOR,
CONCENTRATION, OR C ERTIFICATE
SECTION A (Completed by stu dent--please print CLEARLY or type)
__________________________ _________ _____________________ ___ _____ _____-____-_____ __________
Name (Last) (Preferred First Name) (Middle) CSU ID Date
__________________________ ____________ _____________ _____________________
Student signature Current Major
Class (earned credits): Freshman (0-29) Sophomo re (30-59) Junior (60-89) Senior (90+)
NOTE: Complete separate form for ea ch academic department approving changes.
SECTION B: (Completed by ne w department--please print CLEA RLY or type)
ACTION RE QUESTED: MAJOR, MINOR, C ONCENTRATION, OR CERTIFIC ATE TITLE
Cha
nge 1
st
major to ________ ________ ___________________________ __________
ma Add/Change 2
nd
jor to ________ ________
___________________________ __________
Add/Change
3
rd
maj
or to ________ ________
___________________________ __________
Add concentration(s)
of
________
________
___________________________ __________
Add concentration(s)
of
________
________
___________________________ __________
Add minor of ________
________
___________________________
__________
Add
certificate
of
_____________________________________________________
New
academic department
approval
for
the changes requested
above:
FROM:
_____________________________________________
________________________________
Academic department
Campus a
ddress
The requested
change as shown
above is approved: _____________________________
__________
Department Rep. – Printed Name Phone #
_____________________________ __________
Department Signature Date
SECTION C (Completed by student if applicable--please print CLEARLY or type).
No academic department
approval needed for the changes re quested below:
ACTION RE
QUEST
ED:
MAJOR, MINOR, CONCENTRATION, OR CERTIFICATE TITLE
Drop major of ________
_____________________________________________
Drop minor of _____________________________________________________
Drop concentration of _____________________________________________________
Drop certificate of _____________________________________________________
Switch order
of
majors
1
st
: __________________________________________________
already
on my
record
2
nd
: __________________________________________________
3
rd
:
__________________________________________________
-----------------------------------------------------------------------------------------
-------------------------------------------------------
Note:
This form
must be returned, when approved,
to the O
ffice
of
the Registrar (Centennial Hall), 1063
Campus
Delivery,
to
be
effective.
The
new
department
should request
the
student's
advising file f
rom
the
former
department.
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
