1. Submitted by: _________________________________________

2. Type of Program Change (Check those that apply):

   _____ Title change only
   _____ Combination program created out of closely allied existing programs
   _____ Option(s) added to existing program(s)
   _____ Addition of single-semester certificate program (C0) to existing parent degree

_____ Addition of one-year certificate program (C1) developed from existing parent degree
   _____ Addition of free-standing single-semester certificate program
   _____ Delete program(s)
   _____ Delete option(s)
   _____ Program placed on "Inactive Status" list

_____ Other (attach description)

  • In the left section of the table below, place the program (and options) as they currently appear in the MDHE inventory.
  • In the right section, place the program (and options) as they would appear after changes have been approved.
  • For certificates, place the title, degree and CIP for the parent program in the left section
Current Program Program after the Proposed Change
Title Degree CIP Code Title Degree CIP Code

4. Attach a copy of the "before and after" curriculum, as applicable, and a rationale for the proposed change.

5. Intended date of program change, additional options, or "Inactive Status":



Name/Title of Institutional Officer    Signature    Date

Person to Contact for More Information     Telephone Number