Change Of Program Form
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1ChANgE OF PROgRAm
FORm
Section 1: Student please PRINT clearly in blue or black ink
Full Legal Name: _____________________________________________________________ Titan ID#: _________________________
Current Program: _______________________________ Program Code: _____________
___Certificate ___ Diploma ___ Degree
New Program: __________________________________Program Code: _____________
___Certificate ___ Diploma ___ Degree
Effective Term: Fall_______ Spring_______ Summer ______
Year: __________
Student’s Signature: ______________________________________________ Today’s Date: _________________________________
Section 2: Career Evaluator Please Print clearly - Kirkland Bldg. Suite 127 - Current Program
( Review SOATEST/ SHACRSE): New program scores or courses met? Yes ____ No _______________________
Required Provisional Course(s) (circle):
READ 0090 MATH 0090
ENGL 0090
Admit Type: __________________________
Other admissions requirements needed: ___________________________________________________________________________
Mandatory Program Orientation Required: Yes_____ No _____
Staff’s Signature _________________________________________________ Today’s Date: __________________________________
Staff’s Name Please Print________________________________________________________________________________________
Section 3: Current Program of Study
Current Advisor/Program Chair Name: ___________________________________________Location:__________________________
Number of classes to complete Current program: __________________
Faculty Name PRINT: _____________________________Signature: ______________________________ Today’s Date: ___________
Section 4: Prospective/New Program of Study (Register the student TODAY or attach ATC Schedule form of suggested classes)
New Advisor/Program Chair Name______________________________________________ Location___________________________
Faculty Name PRINT: ______________________________Signature: ______________________________Today’s Date: ___________
Section 5: Financial Aid Office Kirkland Bldg. Suite 159
1. Will the Financial Aid award be affected by making this change? Yes _____ No_____
2. If ‘Yes’, please indicate how FA it will be affected: ______________________________________________________________
3. Are you a U. S. Veteran receiving VA education benefits?
Yes____ (See Financial Aid VA Rep.)
No ____ (VA signature not required)
4.
The student has been advised regarding how this proposed Change of Program will impact his/her current Financial Aid (FA) award.
5. Financial Aid Staff Signature: ___________________________________________________ Today’s Date: ________________
6. Certifying VA Representative’s Signature: _________________________________________ Today’s Date: ________________
Section 6: Registrar’s Office - Kirkland Bldg. Suite 159
1. Student has all required signatures to process this form. Yes_____
No_____
2. Program Code (SFAREGS) and a Faculty Advisor (SGAADVR) have been changed. Yes _____ No______
3. If schedule form was attached per Section 4 under Advisement, were classes keyed: Yes______ No______
4. Student received Registration Packet: Yes_____
No ______
5. Registrar’s Office Staff Signature: ___________________________________________Date Processed:___________________
Registrar’s Office Staff PRINT: ____________________________________________________________________________________
(Please refer to the Student Calendar for the last day to apply for change of major. Dates are listed for each term)
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