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Form 13 - Request For Change In Specialization

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Part A is fillable

University of Hawai‘i  Office of Public Health Studies  Department of Public Health Sciences

FORM 13: REQUEST FOR CHANGE IN SPECIALIZATION

Instructions to Student: [ 1 ] Complete Part A; [ 2 ] Have your present (interim or permanent) faculty advisor complete Part B;

[ 3 ] Submit this form to the Head of the specialization you wish to enter; [ 4 ] The Head of the specialization completes Part C

and forwards to OGSAS, Biomed D-204; and [ 5 ] OGSAS sends to the Graduate Chair to complete Part D. You will be

notified of the action on your request via email.

PART A: STUDENT

1. STUDENT’S NAME (LAST, FIRST MI):

3. STUDENT’S EMAIL ADDRESS:

2. SEM/YR ADMITTED TO PROGRAM:

4. CURRENT AREA OF SPECIALIZATION (Select one):

REQUESTING CHANGE IN SPECIALIZATION TO (Select one):



EPIDEMIOLOGY



HEALTH POLICY & MANAGEMENT



NATIVE HAWAIIAN & INDIGENOUS HEALTH



SOCIAL & BEHAVIORAL HEALTH SCIENCES

5. JUSTIFICATION FOR CHANGE IN SPECIALIZATION:

I AM AWARE THAT IF MY REQUEST IS APPROVED, IT MAY AFFECT THE LENGTH OF MY STUDY PERIOD.

Student’s signature: ______________________________________________________________

Date: __________________________________

PART B: PRESENT FACULTY ADVISER

I HAVE DISCUSSED THE REQUEST FOR CHANGE IN SPECIALIZATION WITH THE STUDENT. MY COMMENTS ARE:

Present faculty advisor’s signature: __________________________________________________________

Date: _________________________________

PART C: HEAD OF NEW SPECIALIZATION

1. CHECK ONE:



Approval is recommended; student has satisfactory background and preparation for my program.



Approval is recommended provided the student completes the specific deficiencies listed below before transferring:



Approval is not recommended. Reason:

2. IF APPROVAL IS RECOMMENDED, COMPLETE THE FOLLOWING:



 As a result of the change in specialization, the expected date of graduation is

changed

unchanged.

 The expected date of graduation (semester/year): _______________________________________________.

 Name of new faculty advisor assigned to this student: _______________________________________________.

Head of new specialization’s signature: ________________________________________________________

Date: ________________________________

PART D: GRADUATE CHAIR



The change in specialization is approved.

The change in specialization is not approved.

Graduate Chair’s signature: ________________________________________________________________

Date: _________________________________

FORM13_SPEC (02/13)

Form 13 - Request For Change In Specialization

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