student request for program modification- PhD Program
Important: Please complete Sections I-IV and have your Advisor complete Section V before
submitting. Note that Section IV must be completed (including all previous, current and planned
courses) regardless of type of request. Incomplete forms will be returned to the student for the
addition of missing data before consideration by the Program Director.
A student can request a program modification for the following reasons: extension to complete
degree; extension of an incomplete grade beyond 30 days; substitutions for required course; or other
curriculum plan adjustments. The Program Director reviews all requests and reserves the right to
consult the Doctoral Committee. Students will be mailed a signed copy of the decision.
Return completed form to Assistant Director, Academic & Student Services Doctoral Program McGuinn 119
I. Name:
_______________________________________ Date: __________________
Address: _______________________________________________________________
_______________________________________________________________
Phone:
_____________________________
BC Email:
Eagle ID: __ __ __ __ __ __ __ __
_____________________@bc.edu
II. Requested Change (Advisor signature required. See Section V.)
a. Extension to complete degree
Additional semesters requested: _______________________
b. Extension of an Incomplete beyond 30 Days: (complete Section III)
Course name and number:
_______________________
Faculty name:
_______________________
Extension request:
____________________________________
____________________________________
Completion date:
_______________________
Faculty signature (required): _______________________
c. Substitutions for required course
Required Course name and number:
_______________________
Suggested Replacement course name and number:
_______________________
d. Other curriculum plan adjustments:
Summary of Suggested Modification: ______________________________________
III. Explanation of Request: (Briefly describe request)
____________________________________________________
______________
_____________________________________________________
Date
Student's Signature
IV. Proposed Program of Study for Degree Completion
Please list all courses — including previous, current and planned courses — using both course # and
course name. The offering of specific electives cannot be guaranteed in any given semester.
Students can attach their individualized Study Plans to this form in lieu of the below grid. No action will
be taken if this section below is incomplete or if a Study Plan is not included.
Fall
1.
SW
Year I*
20___ -20___
2.
3.
4.
5.
1.
SW
SW
SW
SW
SW
Year II*
20___ -20___
2.
3.
4.
5.
1.
SW
SW
SW
SW
SW
Year III*
20___ -20___
2.
3.
4.
5.
SW
SW
SW
SW
Spring
1.
2.
3.
4.
5.
1.
2.
3.
4.
5.
1.
2.
3.
4.
5.
SW
SW
SW
SW
Summer
1.
2.
3.
4.
SW
SW
SW
SW
SW
SW
SW
SW
SW
1.
2.
3.
4.
SW
SW
SW
SW
SW
SW
SW
SW
SW
SW
1.
2.
3.
4.
SW
SW
SW
SW
Year IV*
20___ -20___
1.
2.
3.
4.
5.
SW
1.
SW
2.
SW
3.
SW
4.
SW
5.
SW
SW
SW
SW
1.
2.
3.
4.
SW
SW
SW
SW
SW
*For example, 2013-2014 academic year.
V. Advisor’s comments regarding this request: _____________________________________
______________________________________________________________________________
______________________________________________________________________________
Recommended
______
Not Recommended ______
___________________________________________________
Advisor Name (Please Print)
___________________________________________________
Advisor’s Signature
Date
VI. Program Director’s comments:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Action Taken
Recommended
______
___________________________________________________
Program Director
Date
Not Recommended ______
No Action taken
______
cc: Program Director, Student file, Advisor, & Student
Last updated: 9.1.13