Graduate Application Change Form - Texas Tech University Page 3
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3Graduate Application
Applicant Name: _________________________________________________________
Change Form
PAGE THREE
TechID Number: _________________________________________________________
Have you ever been dismissed, suspended or placed on probation at this or any other institution?
_____ Yes
_____ No
If yes, please provide a written explanation (including dates) below:
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Please continue writing on the back of this form if you need additional space.
I certify that the information I have provided is complete and correct, and I understand that the submission of false information is
grounds for rejection of my application, withdrawal of any offer of acceptance, cancellation of enrollment and/or appropriate
disciplinary action. I agree to notify the proper officials of the institution of any changes in the information provided. If my
application is accepted, I agree to abide by the policies, rules and regulations at any college to which I am admitted. I authorize
the college to verify the information I have provided.
_____________________________________________________
________________________________________
Applicant Signature (unsigned form will delay processing)
Date
NO ELECTRONIC SIGNATURES ACCEPTED
Rev. September 2014
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