Request to Change Programs

Request to Change Programs
Student Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Email*
example@example.com
Current Program:*
Program Change:*
Reason for Change*
I request the changes indicated above. By my signature, I acknowledge my responsibility for payment of the tuition and fees generated by this change. I acknowledge that i have read and understand Tom P. Haney Technical College's policies for withdrawal and refunds. I understand that changes in my program will change my paid through date, SAP date for finanical aid and estimated completion date.
Signature*

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Date

MonthDayYear
Date
Guidance Approval: Yes | No

Signature:_________________________

Financial Aid Approval: Yes | No

Signature:_________________________

Administration Approval: Yes | No

Signature:_________________________
Should be Empty: