CHANGE REQUEST FORM
NEW PROGRAM OFFERING AT AN EXISTING OFF-CAMPUS SITE
Use this form to request authorization to deliver a degree or degree program that has previously been
approved by the Chancellor at a site that has been previously approved by the Chancellor’s staff. A
change request is required when the institution intends to deliver fifty percent or more of the
requirements of a major (excluding internships, clinical practicum, field experiences, and student
teaching) at the site. If the institution is requesting authorization to deliver multiple approved programs
at an off-site location, complete and submit a separate form for each program.
RACGS institutions submitting requests for graduate programs should submit its request to Char Rogge
at crogge@regents.state.oh.us. All other requests should be submitted to mexline@regents.state.oh.us.
Documents may be submitted as Microsoft Office documents (e.g., Word or Excel) or as PDF documents.
Please submit your request at least 60 days before the proposed change is to be implemented. The
institution will be notified that the request was received and assigned an institutional mentor within
seven business days of submitting its request. The institutional mentor will contact the individual listed
on the form to discuss the request.
Institutions that are regionally accredited by the Higher Learning Commission of the North Central
Association of Colleges and Schools (HLC) may submit, in lieu of this document, the commission’s
Substantive Change Application. If the institution is already approved by the commission to offer the
program at the off-campus location, the institution may submit page two of this document and evidence
from the commission that the request has been approved by HLC.
25 South Front Street
Columbus, Ohio 43215
phone 614.466.6000
fax
614.466.5866
web www.OhioHigherEd.org
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Date of submission:
Name of institution:
Primary institutional contact for this request:
Name
Title
Phone number
E-mail
Name of program to be offered at the site:
Address of the delivery site (site must be previously approved):
Proposed implementation date:
Date that the request received final approval from the appropriate institutional committee:
Educator Preparation Programs:
Indicate whether the program leads to educator preparation licenses or endorsements.
Licensure
Endorsement
Yes/No
Yes/No
Rationale:
Briefly describe the rationale for offering the program at this site. In your response, indicate whether the
program to be offered at the site will be time limited or ongoing.
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SECTION 1: CHANGES NEEDED TO ACCOMMODATE THE NEW PROGRAM
Academic and Administrative Leadership and Services
1.1 Describe the changes in academic and administrative leadership (if any) that will be needed to
accommodate the new program.
1.2 Describe the changes (if any) that will be needed in the site’s existing administrative services (e.g.,
admissions, financial aid, registrar, etc.) to accommodate the new program. If such services are not
available at the site, describe how students in the new program will access such services.
1.3 Describe changes (if any) that will be needed in the site’s existing academic student services (e.g.,
advising, tutoring, counseling, placement services, etc.) to accommodate the new program. If such
services are not available at the site, describe how students in the new program will access such
services.
Resources and Facilities
1.4. Describe the changes in resources and facilities (e.g., classrooms, computer labs, laboratories, study
areas, social areas, technology, and other learning environments) that will be needed to
accommodate the new program and provide a timeline for implementing the changes.
1.5 Describe any additional library resources (e.g., personnel, space, technology, etc.) that will be needed
to accommodate the new program at the site and provide a timeline for implementing the changes.
1.6. If a full-service library is not available onsite, please indicate how students, faculty and staff in the
new program will access the resources and services of the main campus library.
SECTION 2: PROGRAM INFORMATION
Additional Program
2.1 Using the chart below, please list the degree/program area that is being added for delivery at the
site. Include a list of the courses that will be available onsite as an appendix item.
Note: For the purposes of this application, the program (degree or major within the degree) to be
offered at the site must have been approved by the Chancellor for delivery at the main campus
location. If the program has not been previously approved (or if the content of the program varies
substantially from the approved program), additional documentation may be required to complete the
review.
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Title of
Degree/Major
or Program Component
Full
Program
Available
On-Site
e.g.,
General Education
Partial
Program
Available
On-Site
X
e.g.,
B.S. with a Major in Accounting
X
Alternative delivery options
2.2 Indicate whether alternative delivery options are available for the program at the proposed site and
indicate whether this is different from the delivery option used for the approved program at other
locations:
Accelerated
Hybrid/blended
Online
Available
Currently Used in the Approved Program
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
If any of the above options will be available at the new location and have not been previously approved
as part of the approved program, additional documentation may be required to complete the review.
SECTION 3: FACULTY
3.1 Complete a faculty matrix for the program being added at the site. A faculty member must be
identified for each course to be taught at the site during the first two years of program delivery. If a
faculty member has not yet been identified for a course, indicate that as an “open position” and
describe the necessary qualifications in the matrix (as shown in the example below). A copy of each
faculty member’s CV must be included as an appendix item.
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Name of
Instructor
e.g.,
Mary
Davis
Open
Position
Rank or
Title
e.g.,
Professor,
Assistant
Professor,
Adjunct
Professor,
Lecturer,
etc.
e.g.,
Professor,
Assistant
Professor,
Adjunct
Professor,
Lecturer,
etc.
FullTime
or
PartTime
FT or
PT
FT or
PT
Degree Titles,
Institution,
Year
Include the
Discipline/Field
as Listed on the
Diploma
e.g.,
M.S.,
Accounting, ABC
University, 1990
Years of
Teaching
Experience
In the
Discipline/
Field
number of
years
experience
Additional
Expertise in
the
Discipline/
Field
(e.g., licenses,
certifications)
e.g.,
CPA
Title of the
Course(s)
This
Individual
Will
Teach in the
Proposed
Program
Number of
Courses
this
Individual
will
Teach Per
Year at
All Campus
Locations
Include the
course prefix
and number
e.g.,
ACC 100:
Introductory
Accounting
e.g.,
8
ACC 248:
Managerial
Accounting
e.g.,
Master's in
Economics
required
e.g., 35
years
minimum
e.g.,
ECON200:
Microeconomi
cs
e.g.,
4
ECON201:
Macroeconom
ics
etc.
3.2 Describe future faculty staffing plans for the program. In your response, include a description of the
institution’s plans, if any, for adding courses and faculty after the initial two years of operation and a
description of the plans to add faculty in response to increases in student enrollment.
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SECTION 4: MARKET/WORKFORCE NEED
Market Research/Evidence of Workforce Need
4.1 Indicate whether the institution performed a needs assessment/market analysis to determine the
need for the program at the proposed site. If so, briefly describe the results of those findings.
4.2 Indicate the projected enrollments for the program over the next three years.
4.3 Indicate whether the institution consulted with advisory groups, business and industry, or other
experts when considering moving the program to the proposed site. If so, briefly describe the
involvement of these groups in the development of this request.
Commitment to Program Delivery at the Site
Provide a statement of the institution's intent to support the program at the proposed site, and
assurances that, if the institution decides in the future to close the site, the institution will provide the
necessary resources/means for matriculated students to complete the program.
APPENDICES
Appendix items
List the appendix items that are included with the request, in the order they are referred to in the
proposal. Appendix items should be clearly labeled and submitted electronically as PDF documents or as
Microsoft Office documents (e.g., Word or Excel).
(Insert name of the institution) verifies that the information in the application is truthful and accurate.
Signature of the Chief Presiding Officer or the Chief Academic Officer
(Insert name and title of the chief presiding or chief academic officer)