SIGNATURES OF APPROVAL (AGREES WITH RECOMMENDATION)
SIGNATURE DATE
PROGRAM COORDINATOR
DEPARTMENT CHAIR
CURRICULUM CHAIR
VP OF INSTRUCTION
WEBMASTER (WEBSITE)
ADM. ASSIST. FOR INSTRUCTION (CATALOG)
WILLISTON STATE COLLEGE
PROGRAM CHANGE/DELETE/ADDITION FORM
PROGRAM CHANGE REQUEST PROGRAM DELETION REQUEST PROGRAM ADDITION REQUEST
TITLE OF PROGRAM TOTAL CREDITS
CIP CODE POG SUBMITTED Y
N
REQUIRES ADMISSION Y
N
PROGRAM
CERTIFICATE
DIPLOMA
CERT OF COMPLETION
EFF START DATE FALL 20__ SPRING 20__ SUMMER 20__
TERM AND YEAR OF REQUESTED IMPLEMENTATION
CONTACT PERSON DATE DEPARTMENT
EMAIL PHONE
JUSTIFICATION FOR NEW PROGRAM, PROGRAM CHANGE OR TERMINATION
DESCRIPTION OF NEW PROGRAM OR PROGRAM CHANGE (CHECK ALL TO BE IMPACTED AND ADDRESSED BELOW)
COURSE ADDITIONS
COURSE DELETIONS
MODIFICATIONS
OTHER PROGRAM IMPACT
OTHER COURSE IMPACT
ARTICULATION AGREEMENTS
ACCREDITATION
FACILITIES/EQUIPMENT
FACULTY IMPACT
PRE/CO REQUISITE CONSIDERATIONS
GRADUATION REQ’S
IMPACT ON CONT. STUDENTS