Fillable gram Modification Form Checklist Pro The sections listed (California State University, Dominguez Hills)

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gram Modification Form Checklist Pro The sections listed (California State University, Dominguez Hills)

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Office of Academic Programs • WH 440 • (310) 243-3308
REQUEST FOR A PROGRAM MODIFICATION
Academic Programs (Rev. 05/2020)
1
Pro
gram Modification Form Checklist
The sections listed below are required on the program modification form. Please review the proposal and check off each section
to indicate that each section has been completed and include the completed checklist as the cover page for the proposal. If you
have any questions regarding this checklist and/or form, please contact the Office of Academic Programs.
Proposed effective term (i.e., fall 2021)
Include current program information in section #1.
Complete proposed changes
a. Select all that apply and complete/attach ALL relevant information
Evidence of consultation with affected departments/programs
Campus-wide sharing (Curriculum Register) synopsis
Office of Academic Programs • WH 440 • (310) 243-3308
REQUEST FOR A PROGRAM MODIFICATION
Academic Programs (Rev. 05/2020)
2
Prop
oser Name: Email: Date:
College: Dept.:
Ext.:
Prop
osed Effective Date:
1.
Current Program: Identify the following information.
Full & Exact Degree Designation & Title
:
Graduate Undergraduate State Support Self-Support
Full
y Face-to-face Fully Online
Hybrid
%
Face-to-face:
% Online:
Program Name:
Program Type: Please note, if Major is selected, the proposed changes will apply to ALL underlying
options/concentrations/emphases.
Maj
or Minor Concentration/Option/Emphasis
Cred
ential Certificate
2.
PROPOSED CHANGES: Check all changes that apply and provide the relevant information.
Change degree designation:
i.
Provide a brief rationale for change in degree designation below:
ii.
Attach revised Catalog Copy using track changes. Please contact your college’s assigned catalog editor for
a Word version of your current catalog copy.
iii.
Attach assessment plan and curriculum map. Include current program assessment plan and curriculum map
for comparison with proposed changes.
Select College
Select Semester
Select year
Office of Academic Programs • WH 440 • (310) 243-3308
REQUEST FOR A PROGRAM MODIFICATION
Academic Programs (Rev. 05/2020)
3
Title Change
i.
List proposed title changes for each degree program, minor, certificate, and/or
concentrations/emphases/options below.
Current Title:
Proposed Title:
ii.
Provide a brief rationale for change in title(s) below:
iii.
Attach revised Catalog Copy using track changes. Please contact your college’s assigned catalog editor for a
Word version of your current catalog copy.
Course Changes: Include department chair impact statement with course proposals
i.
If adding new course(s) or proposing course modification(s) related to a change in units, attach New Course
form and/or Course Modification form.
ii.
If adding an existing course or courses that have already been approved, include the course subject, course
number, course title, and course description as listed in the catalog for each course.
Office of Academic Programs • WH 440 • (310) 243-3308
REQUEST FOR A PROGRAM MODIFICATION
Academic Programs (Rev. 05/2020)
4
iii.
List ALL courses, existing and proposed (new and/or modifications), proposed to be added to the degree
program below. Include course subject, course number, course title for each course.
iv.
If deleting/removing a course or courses, list the course subject, course number, and course title for each
course to be removed.
Office of Academic Programs • WH 440 • (310) 243-3308
REQUEST FOR A PROGRAM MODIFICATION
Academic Programs (Rev. 05/2020)
5
v.
Provide a brief rationale explaining the need for the course change(s) below:
vi.
Attach revised Catalog Copy using track changes. Please contact your college’s assigned catalog editor for
a Word version of your current catalog copy.
vii.
If the course change(s) result in a unit change, include revised unit count using template.
viii.
Attach assessment plan and curriculum map. Include current program assessment plan and curriculum map
for comparison with proposed changes.
ix.
Attach revised 4-year and 2-year Roadmap for undergraduate programs using template.
x.
Identify how the program will accommodate currently enrolled students.
xi.
Attach evidence of consultation with affected departments, including those offering prerequisites for
courses being added. [Item to be addressed on page 7]
Restructuring/ changing program requirements without adding or removing a course:
i.
Describe briefly changes to be made to program requirements
Office of Academic Programs • WH 440 • (310) 243-3308
REQUEST FOR A PROGRAM MODIFICATION
Academic Programs (Rev. 05/2020)
6
ii.
Provide rationale explaining the need for restructuring/changing the program requirements below:
iii.
Attach revised Catalog Copy using track changes. Please contact your college’s assigned catalog editor for a
Word version of your current catalog copy.
iv.
Attach revised unit count using template.
v.
Attach revised roadmap(s) as appropriate using template.
vi.
Attach description of how current students will be accommodated students enrolled in current program.
vii.
Attach evidence of consultation with affected departments. [Item to be addressed on page 7]
Changing Culminating Experience
i.
Explain changes to be made to the culminating experience.
Office of Academic Programs • WH 440 • (310) 243-3308
REQUEST FOR A PROGRAM MODIFICATION
Academic Programs (Rev. 05/2020)
7
ii.
Provide a brief rationale explaining the need for restructuring/changing the culminating experience.
iii.
Attach teach-out plan for students enrolled in current program.
iv.
Attach revised Catalog Copy using track changes. Please contact your college’s assigned catalog editor for a
Word version of your current catalog copy.
3.
Does this proposal affect another department(s)
If yes:
i.
List affected department(s)
ii.
Attach evidence of consultation with affected departments.
4.
Attach dean's impact statement.
i.
Reference the dean's impact statement checklist.
Office of Academic Programs • WH 440 • (310) 243-3308
REQUEST FOR A PROGRAM MODIFICATION
Academic Programs (Rev. 05/2020)
8
5.
Curriculum Register Synopsis: Include summary of changes to be posted for campus-wide sharing.
Office of Academic Programs • WH 440 • (310) 243-3308
REQUEST FOR A PROGRAM MODIFICATION
Academic Programs (Rev. 05/2020)
9
1.
Faculty Proposer (Print)
Signature
Date
2.
Department Chair/Program Coordinator (Print)
List names of department faculty who approved
this proposal. (Note: The number of names listed
must constitute a simple majority of voting faculty
members in the department.)
Signature
Date
3.
Dept. Curriculum Com. Chair/Faculty Designee
(Print)
Signature
Date
4.
College Curriculum Committee Chair (Print)
Signature
Date
5.
University Curriculum Committee Chair (Print)
Signature
Date
6.
VPAA/Designee (Print)
Signature
Date
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gram Modification Form Checklist Pro The sections listed (California State University, Dominguez Hills)

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Completed 18 August 2020

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