CHANGE REQUEST
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 the multiple approved
program(s) at off-site locations, complete and submit a separate form for each program.
Questions about the form and/or your request may be directed to Jane Fullerton, Consultant, Teacher
Education Programs, at (614) 466-6000 or jfullerton@regents.state.oh.us.
Please submit your request at least 45 days before classes begin. Send the completed form and
appendices via email to jfullerton@regents.state.oh.us Documents may be submitted as Microsoft
Office documents (e.g., Word or Excel) or as PDF documents. If the electronic documents are too
numerous or too cumbersome to email, you may copy them to a CD or “flash drive” and then mail the
CD or flash drive to our office.
30 East Broad Street | 36th Floor | Columbus, Ohio 43215-3414 | phone 614.466.6000 | fax 614.466.5866
www.OhioHigherEd.org
CHANGE REQUEST:
NEW PROGRAM DELIVERY AT AN EXISTING OFF-CAMPUS SITE
Date of submission:
Name of institution:
Course Delivery Site (site must be previously approved):
Program to be delivered at the site:
Proposed start date:
Date that the request received final approval from the appropriate institutional committee:
Primary institutional contact for the request
Name:
Title:
Phone number:
E-mail:
Educator Preparation Programs:
Indicate if the program to be delivered leads to and educator preparation license or endorsement.
Licensure
Yes/No
Endorsement
Yes/No
If educator preparation licenses or endorsements are associated with any of the programs offered at the
new location, please contact Kelly Gaier, Academic Quality Assurance, at (614) 728-3095 or
kgaier@regents.state.oh.us, so that he can coordinate your request with individuals in our office who
oversee the approval of educator preparation programs.
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.
Describe how the request aligns with Chancellor’s strategic plan for higher education in the state of Ohio
(public institutions only).
Change Request: New Program Offering at an Existing Off-Campus Site
Revised: March, 2010
Page | 1
SECTION 1: CHANGES NEEDED TO ACCOMMODATE THE NEW PROGRAM(S)
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(s) 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(s) will access the resources and services of the main campus library.
Change Request: New Program Offering at an Existing Off-Campus Site
Revised: March, 2010
Page | 2
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. If general education courses are being added as part of this request, include that as a separate
program area. (Examples are provided below.) 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), please contact Jane Fullerton, Consultant, Teacher Education
Programs, at (614) 466-6000 or jfullerton@regents.state.oh.us for direction.
Title of
Degree/Major
or Program Component
Full
Program
Available
On-Site
e.g.,
General Education
Partial
Program
Available
On-Site
Comments for Chancellor’s Staff,
(As Needed)
X
e.g.,
B.S. with a Major in Accounting
X
Senior-level courses available on
main campus only
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, please contact Jane Fullerton, Consultant, Teacher Education
Programs, at (614) 466-6000 or jfullerton@regents.state.oh.us for direction.
Change Request: New Program Offering at an Existing Off-Campus Site
Revised: March, 2010
Page | 3
SECTION 3: FACULTY
3.1 Complete a faculty matrix for the program being added at the site. Include a separate matrix if
general education courses are being added. 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.
Program Name: e.g., General Education
Name of
Instructor
Rank or
Title
e.g.,
Professor,
Assistant
e.g.,
Professor,
John Smith Adjunct
Professor,
Lecturer,
etc.
e.g.,
Professor,
Assistant
Open
Professor,
Position
Adjunct
Professor,
Lecturer,
etc.
etc.
FullTime
or
PartTime
FT or
PT
Degree Titles,
Institution,
Year
Include the
Discipline/Field
as Listed on the
Diploma
Years of
Teaching
Experience
In the
Discipline/
Field
e.g.,
M.S.,
Mathematics,
ABC University,
1990
number of
years
experience
e.g.,
Master's in
English required
e.g., 3
years
minimum
Additional
Expertise in
the
Discipline/
Field
(e.g.,
licenses,
certifications
, if
applicable)
Title of the
Course(s)
This Individual
Will
Teach in the
Proposed
Program
Include the
course prefix
and number
Number of
Courses
this
Individual
will
Teach Per
Year at
All Campus
Locations
e.g.,
e.g.,
MTH120:
College Algebra 7
MTH148:
Analytic
Geometry
FT or
PT
Change Request: New Program Offering at an Existing Off-Campus Site
Revised: March, 2010
e.g.,
ENG 100:
English
Composition I,
e.g.,
4
English
Composition II
Page | 4
Program Name: e.g., Bachelor of Science with a Major in Accounting
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
Include the
course prefix
and number
e.g.,
ACC 100:
Introductory
Accounting
Number of
Courses
this
Individual
will
Teach Per
Year at
All Campus
Locations
e.g.,
8
ACC 248:
Managerial
Accounting
e.g.,
Master's in
Economics
required
e.g., 35
years
minimum
e.g.,
ECON200:
Microeconomic
s
e.g.,
4
ECON201:
Macroeconomi
cs
etc.
Change Request: New Program Offering at an Existing Off-Campus Site
Revised: March, 2010
Page | 5
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.
Change Request: New Program Offering at an Existing Off-Campus Site
Revised: March, 2010
Page | 6
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(s) at the proposed site. If so, briefly describe the results of those findings.
4.2 Indicate the projected enrollments for the program(s) 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(s) to the proposed site. If so, briefly describe the
involvement of these groups in the development of this request.
4.4 Indicate whether any other institution within a thirty-mile radius of your institution currently offers
the program(s). If so, list the institutions that offer the program(s) within this radius (this question is for
public institutions only).
Change Request: New Program Offering at an Existing Off-Campus Site
Revised: March, 2010
Page | 7
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).
e.g.,
Appendix3.1_ General Education Courses
Appendix3.1_ Accounting Courses
Appendix3.1_ Nursing Courses
Appendix4.1_General Education CV_Smith
Appendix4.1_General Education CV_Jackson
Appendix4.1_General Education CV_Jones
Appendix4.1_General Education CV_Brown
Appendix4.1_Accounting CV_Davis
Appendix4.1_Accounting CV_Barnes
Appendix4.1_Nursing CV_Marshall
Appendix4.1_Nursing CV_Borden
Appendix4.1_Nursing CV_White
Change Request: New Program Offering at an Existing Off-Campus Site
Revised: March, 2010
Page | 8
Commitment to Program Delivery at Site
Provide a statement of the institution's intent to support the program(s) 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(s).
Verification and Signature
(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)
Change Request: New Program Offering at an Existing Off-Campus Site
Revised: March, 2010
Page | 9