SUBSTANTIVE CHANGE APPLICATION FORM Date of Application __________________________________ From: _____________________________________________ Accreditation Liaison Officer (ALO) Cc: _______________________________________________ NWCCU Staff Liaison Contacted Name of Institution: ______________________________________________________________________________ ALO Phone/Email: ______________________________________________________________________________ Other Contact Person: ____________________________________________________________________________ Name of Proposed Program or Change: _______________________________________________________________ Date of Institutional Governing Board Approval: (if applicable) _____________________________________________ TYPE OF CHANGE (Examples): (check all that apply) Substantive Change – Substantive Change Review Panel: Minor Change – Staff Review: □ Curriculum revisions which do not significantly affect □ Any change in institutional mission, legal status, form of program outcomes control, ownership, or sponsorship □ Pilot study or a limited time offering □ Addition of a new degree level or branch campus □ Addition of offerings less than a year in length to an □ Acquisition of, or merger with, another existing site or location not significantly different from institution/organization existing offerings □ Teach-out agreement with another institution □ Addition of degree program (undergraduate or graduate) or □ Contractual agreements with non-accredited a certificate program of 30 semester or 45 quarter credits in entities/institutions length and related to existing offerings □ Initial education offering as competency-based (or direct □ Placement in moratorium, suspension, or elimination of a assessment) learning degree program (undergraduate or graduate) or a certificate □ Initial course or program offerings through distance program of 30 semester or 45 quarter credits in length education delivery □ Addition of courses in distance education delivery and less □ Program offerings outside of NWCCU region including than 50% of total required credits for a program international locations completion but not previously evaluated for delivery □ Contractual agreements with accredited organizations modality □ Substantial increase or decrease in program length, or clock □ Addition of a site or location in geographic proximity to the hours to credit hours (or vice versa) institution’s main campus (within 20 miles) □ Addition of courses or a program significantly different □ 50% or more of a degree (undergraduate or graduate) or from existing offerings since the last NWCCU evaluation certificate program’s requirements completed through □ Additional site or location geographically apart from main distance education or competency-based learning with campus (more than 20 miles) previous evaluation of delivery modality □ Other (please specify: ________________________________________________________________________________ Anticipated Date of Implementation of Proposed Change: _________________________________ Request of NWCCU: □ Please have my Institutional Staff Liaison contact me to discuss the nature of the program or change. Please refer to the NWCCU website at www.nwccu.org for the Substantive Change Policy. Submit the application form one month prior to the anticipated date of submission of the proposal for minor or substantive changes. ___________________________________ ALO Signature _______________________________________________ ALO of Partnering Institution Signature, if applicable _____________________________________________ President or Provost Signature Mail to: NWCCU, Attn: Substantive Change, 8060 165th Ave NE, Suite 100, Redmond, WA 98052. Or, E-Mail: pgoad@nwccu.org or ebuckley@nwccu.org. You will receive confirmation of the appropriate change category. For Internal NWCCU Processing Only (follow-up): ___________________________________________________________________________________________________ ___________________________________________________________________________________________________