Request To Change Academic Program
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Undergraduate Students
Request to Change Academic Program
Box 1
(Please Print Clearly)
name __________________________________________________________________________________________________________
last
First
Middle/Maiden
anticipated Date of Graduation ____________
______________
Clemson iD#________________________________
(cxxxxxxxx)
Month
year
Please complete all applicable blanks. (Instructions to follow.) Advisor(s) name and signature(s) are required.
Single Degree
Double Major (limited to BA Programs)
Two Degrees
Three Degrees
Check:
Box 2
n
n
n
n
1)
Program:
____ND ____BA ____BS ____BFA ____BLA
Primary Major: ______________________________________________
Secondary Major (if Double Majoring) _____________________________
Catalog Year: _______________________________________________
Catalog Year: ________________________________________________
Concentration/Emphasis Area (if applicable): ____________________
Concentration/Emphasis Area (if applicable): _______________________
___________________________________________________________
___________________________________________________________
Minor (if applicable):______________________Catalog Year __________
Minor (if applicable):______________________Catalog Year ________
Advisor’s Name (print): ________________________________________
Primary’s Advisor’s Name (print) _______________________________
Signature__________________________________Date: _____________
Date: ______________________________________________________
2)
Program:
____ND ____BA ____BS ____BFA ____BLA
Primary Major: _______________________________________________
Secondary Major (if Double Majoring) _____________________________
Catalog Year: ________________________________________________
Catalog Year: ________________________________________________
Concentration/Emphasis Area (if applicable): _______________________
Concentration/Emphasis Area (if applicable): _______________________
___________________________________________________________
___________________________________________________________
Minor (if applicable):______________________Catalog Year __________
Minor (if applicable):______________________Catalog Year __________
Advisor’s Name (print) _________________________________________
Advisor’s Name (print): ________________________________________
Signature__________________________________Date: _____________
Signature__________________________________Date: _____________
3)
Program:
____ND ____BA ____BS ____BFA ____BLA
Secondary Major (if Double Majoring) _____________________________
Primary Major: _______________________________________________
Catalog Year: ________________________________________________
Catalog Year: ________________________________________________
Concentration/Emphasis Area (if applicable): _______________________
Concentration/Emphasis Area (if applicable): _______________________
___________________________________________________________
___________________________________________________________
Minor (if applicable):______________________Catalog Year __________
Minor (if applicable):______________________Catalog Year __________
Advisor’s Name (print): ________________________________________
Advisor’s Name (print): ________________________________________
Signature__________________________________Date: _____________
Signature__________________________________Date: _____________
When all program information is completed above, please obtain applicable signatures below.
Box 3
Student’s Signature ________________________________________________________________________________ Date _________________
Name of Academic Advisor, Departmental Chair/Designee, of Primary Major ______________________________________________________
Signature: _____________________________________________________________________________________ Date ________________
(Please retain a copy of form if needed for departmental records.)
(If changing from Primary major to another) Former Primary Major: ______________________________________________________________
Name of Academic Advisor, Departmental Chair/Designee in Former Dept. ___________________________________Date _________________
Signature: _____________________________________________________________________________________ Date ________________
(Please retain a copy of form if needed for departmental records.)
Submit completed form to the Enrolled Student Services Office, 104 Sikes Hall.
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