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Academic Program Change Form

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PROGRAM CHANGE FORM

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

Degree

CIP Code Title of New Program

Degree

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.

Academic Program Change Form

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