Western Illinois University
Request for Change of Status
School of Graduate Studies
___I am currently in a graduate degree program at Western Illinois University and would like to change my program of study. If
appropriate please transmit my admission materials to the following department so they may consider my admission into their
program.
OR
___I am currently a non-degree graduate student and would like to apply to a degree program. Please transmit my admission materials
to the following department so they may consider my admission into their program.
___Accountancy
___Elementary Education
___Physics
___Biology
___Engineering Technology Leadership
___Political Science
___Business Administration
___English
___Psychology – General
___Chemistry
___Environ. Sci.:Large River Ecosystems (PhD)
___Psychology – Clinical/Comm. Mental Health
___College Student Personnel
___Geography
___Psychology – School
___Communication
___Health Sciences
___Reading
___Communication Sciences and Disorders
___History
___Recreation, Park & Tourism Administration
___Computer Science
___Instructional Design and Technology
___Sociology
___Counseling (School, Clinical Mental Health)
___Kinesiology
___Special Education
___Economics
___Law Enforcement & Justice Adm.
___Sport Management
___Educational Leadership (MS Ed)
___Liberal Arts and Sciences
___Theatre
___Educational Leadership (EdS)
___Mathematics
___Educational Leadership (EdD)
___Museum Studies
___Ed & Interdisciplinary Studies
___Music
Other:
___Second bachelor’s degree (specify degree):
___Post-baccalaureate certificate (specify certificate):
___Non-degree
Name: ___________________________________________________
WIU ID No.: _____________________________
Current address: ____________________________________________________________________________________________
Email address: _____________________________________________
Phone number: ___________________________
If currently a graduate degree-seeking student, do you intend to complete your current program before beginning a new program of
study? ___Yes ___No
If applicable, do you wish to have your previous goals statement and letters of recommendation forwarded to the new program
indicated above? ___Yes ___No
Semester to begin program: ____________________ Primary attendance location: ___Macomb ___Quad Cities ___Other
Today’s date: _________________________
___Student Certification (This certification must be signed before action can be taken on this request.) I certify that the statements I
have made on this form are correct and complete.
Western Illinois University
School of Graduate Studies
1 University Circle
Macomb, IL USA 61455-1390
Phone (309)298-1806; Fax (309)298-2345
www.wiu.edu/grad; Email: Grad-Office@wiu.edu
6-26-14
Signature: ________________________________________________________
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