Instructions
REQUEST FOR PROGRAM MODIFICATION FORM
Department: Enter the name of the department or program proposing the course modification.
Extension: Enter the extension of the department or program office proposing the course
modification.
College. Enter the acronym of the school/college of the department or program proposing the course
modification.
Attach Appropriate Responses and/or Forms
1. Name of Program: Enter the name of the program being modified.
2. Type of Program: Enter the level of program (Undergraduate or Graduate) and the type of
program (Major, Option/Concentration, Minor, Certificate, or Credential).
3. Proposed Effective date for Change: Indicate the first term (fall, spring, winter session,
summer session) and year in which the modified program will be offered
4. Justification for program modification (answer all):
a.
b.
Justify the need for modifying, the program..
Indicate if the program is being modified in response to academic review or
accreditation recommendations. If not, please indicate: N/A.
5.
Indicate all resources required. Please specify all resources needed (including but not
limited to faculty, equipment, space, library, etc.). Include existing and additional resources
needed.
6.
Plans for accommodating students affected by the modification or discontinuance.
Please attach the plan for current students. Please indicate expected timeline for completion
of existing program by current students. Indicate advising plans for current students (i.e.
continue with existing program or declare current program).
7.
Plans for changing modality and/or location.
If planning to change modality (i.e. online), a Substantive Change proposal is also required.
Please include a list of current majors to identify international students. List all additional
locations that will offer the program.
8.
Include responses for the following:.
a.
b.
c.
d.
e.
f.
g.
Summary of the modifications. List proposed changes showing how the new
program differs from the existing program. Departments may include a matrix
showing the changes. For credential programs, please attach formal change
proposal to be submitted to the CCTC.
Include the modified program in catalog format. Please consult current catalog for
formatting information. Contact the Office of Academic Programs for assistance.
Include Program Level Student Learning Outcomes (SLO’s) with the assessment
plan. Indicate where in the program each of the outcomes is assessed. Please
contact the University Student Learning Outcomes and Assessment Coordinator for
assistance.
Indicate whether this change affects other departments (i.e. courses from another
department are added / removed from program). Please provide copies of
correspondence sent to the departments as well as responses received.
Submit proposals for any new, modified or retired courses.
Include a summary of changes to the course utilization for all affected courses (i.e. if
a course is added to the program, indicate whether it is a required, required
alternate, or elective course; list any courses removed from the program that are not
being retired).
For Undergraduate Programs Only, include updated Roadmaps using the
Roadmap Submission form available from the Office of Academic Programs.
.
Signatures: When the proposed program has been reviewed, append the appropriate signature and date in
the space provided. Attach any comments and/or recommendations. Retain a copy of the form and
attachments for your records and forward the materials to the next reviewing authority on the list. Contact the
Office of Academic Programs, ext. 3308 for description of the curriculum review process.
Each reviewer or reviewing body should retain a copy of the proposal and its attachments.
Rev09/12/2011th