Academic Program Change Form

Download a blank fillable Academic Program Change Form in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Academic Program Change Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.


Format PC
1. Submitted by: ______________________________________________________________________
Name of Institution
2. Type of Program Change (Check those that apply):
_____ Title change only (may be submitted as a memo or by responding to item 3 below)
Note: This information must be submitted to the TBR Office of Academic Affairs prior
to implementation so that academic inventory records can be properly maintained.
_____ *Consolidate an existing academic program
_____ *Substantive Curriculum Modification in an existing academic program
_____ Termination of an existing program or concentration
_____ Inactivation of an existing program or concentration (If a program is not reactivated
within a period of three years, the program will automatically be terminated and removed
from the Academic Inventory by December of that year.)
_____ Reactivation of a program that was placed on inactivation within the past 3 y ears
Date of inactivation:
3. Indicate Program Change:
Before the Proposed Change
After the Proposed Change
Title of Old Program or
CIP Code Title of New Program
CIP Code
Certificate Option
or Certificate Option
4.*Attach a copy of the "before and after" curriculum, as applicable, and a rationale for the proposed change.
5. Intended implementation date for program change:
6. For terminations, date phase-out period will end:
7. Briefly describe the reasons for the requested action and the implications that the proposed action will have
on any of the following: 1) fiscal resources, 2) personnel, 3) students or other clientele, and 4) institutional
desegregation objectives.


00 votes

Related Articles

Related forms

Related Categories

Parent category: Business