Change of Program Request Form
Student Information
Student ID:
*
Student Email:
*
example@example.com
Title
*
Mr.
Mrs.
Ms.
Student Name
*
Contact Number:
*
Format: (000) 000-0000.
Degree
*
Undergraduate
Masters
Doctoral
Program:
*
Artificial Intelligence and Computer Engineering
Artificial Intelligence Innovation
Electrical and Computer Engineering
Technology and Creative Innovation
Current Semester:
*
Fall
Spring
Summer
Year
*
Information
Have you spoken with your academic advisor(s) regarding the request?
*
No
Yes
Academic Advisor Name
*
Which program degree are you switching to?
*
Undergraduate
Masters
Doctoral
Program Name
*
Are you currently receiving financial aid?
*
No
Yes
Please provide the reasons for the program change
*
Signature of Student:
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Should be Empty: