PROGRAM CHANGE REQUEST

Today's Date: Today's Date: / MM / DD YYYY
STUDENT'S PERSONAL INFORMATION
Full Name (Last, First, Middle [or initial])
Nickname (if preferred)
Student ID#--if unknown, contact Warner Registrar
Must be 8 digits. Currently Entered: 0 digits.
Preferred Phone Number Preferred Phone Number - ### - ### ####
Preferred E-mail
STATEMENT OF UNDERSTANDING:

I understand that:

1) I cannot use this form to change from:

* department to department (e.g., Educational Leadership to Teaching & Curriculum)
* degree to degree (e.g., MAT to MS, EdD to PhD, etc.)
* discipline to discipline within Teaching & Curriculum (e.g., science to English)
* a program that does not lead to certification to one that does lead to certification
* elementary to secondary or secondary to elementary education
* any standard program to one with a specialty that requires an application (e.g., BCBA)
* any other program or degree to a counseling program.

2) I must contact the Admissions Office to make any of the changes listed in #1 above.

3) If I am receiving a tuition award from Warner School, any change of program must be reviewed by Admissions, and while Warner will try to allow me to keep the tuition award, I am not guaranteed that I will retain any award granted for the original program at time of admission.

4) If I am only adding a second certificate, I should use the online form on Warner's website to apply to the program: https://apply.grad.rochester.edu/register/addprogram.
PROGRAM CHANGE DESCRIPTION

I, the above named student, wish to change my Warner Program of Study, as follows:
FROM THIS DEGREE OR CERTIFICATE
Within this department
In this area (specific title of degree/certificate: e.g., Earth Science 7-12, Mental Health Counseling, etc.)
TO THIS DEGREE OR CERTIFICATE
Within this department
In this area (specific title of degree/certificate: e.g., Earth Science 7-12, Mental Health Counseling, etc.)
SIGNATURES & APPROVALS
Student's Electronic Signature: by typing my FULL LEGAL NAME in the field below, I affirm that I have read and agree with the Statement of Understanding above, that I have discussed this change with my advisor, and that I wish to change my program of study as described above.

I understand this is a legal representation of my signature.
Advisor Name (student to enter name)

(Note to Advisor: please sign and date the form in space to right, then e-mail it to the Warner Registrar.)
Associate Dean (student to enter name)

(Note to Associate Dean: please sign and date the form in space to right, then e-mail it to the Warner Registrar.)

PROGRAM CHANGE REQUEST

PROGRAM CHANGE REQUEST

STUDENT'S PERSONAL INFORMATION

PROGRAM CHANGE DESCRIPTION I, the above named student, wish to change my Warner Program of Study, as follows:

SIGNATURES & APPROVALS

PROGRAM CHANGE DESCRIPTION

I, the above named student, wish to change my Warner Program of Study, as follows: