Declaration of Degree or
Change Program of Study

DIRECTIONS: Students may declare a degree program and/or change their program of study at anytime during the term in which they are enrolled. Before submitting this form, students are strongly encouraged to meet with their academic advisor to discuss the impact a change of degree program and/or change their program of study will have on their educational plan. This can include graduation eligibility and if any prior credits can be applied to the new major. Students changing a degree program and/or program of study must graduate under the degree requirements of the catalog in effect at the time of the major change.

Student Information

First Name

Last Name

Student ID (S#)

Street Address

City

State

Zip Code

Phone Number

Email Address (you will be sent a confirmation once approved):

YES

NO

Are you receiving Veteran’s Educational Benefits? If YES, see the VA certifying official in CC-224

YES

NO

Have you applied for or are you currently receiving financial aid?
(If YES, you are responsible for contacting the Financial Aid office regarding your financial aid eligibility)

YES

NO

State Board and Pueblo Community College policy requires all certificate and degree-seeking students to be assessed or exempt in the basic skills areas of reading, sentence skills, and mathematics. Have you taken all basic skills tests or been exempted from basic skills courses?

Indicate the semester you wish your new major to take effect:

Current Degree/Program of Study

Current Degree Program

Current Advisor:

Current Program of Study:

Requested Degree/Program of Study

Requested Degree Program:

New Advisor:

Requested Program of Study:

Admission to the following programs requires a separate application to the department: Dental Assisting, Emergency Medical Services, Psychiatric Technician, Dental Hygiene, Nursing, Medical Sonography, Occupational Therapy Assistant, Radiological Technology, Physical Therpay Assistant and Respitory Care Practitioner. Students admitted to these programs will receive an acceptance letter from the department. When the department informs Admissions and Records of the acceptance, the major change will be made. If you have an acceptance letter and the major change has not been completed, please bring your acceptance letter to Admissions and Records in CC-224.

Signatures:

Agree

Disagree

I understand that by changing my major I will be responsible for meeting the degree requirements of the catalog in effect at the time of my change in degree program and/or program of study. I certify that the information above is true and accurate.

Student Signature:

Date:

Do Not Write Below This Line

Center for Academic Advising: