PORTLAND STATE UNIVERSITY
CHANGE FORM for EXISTING COURSE
INSTRUCTIONS: Use this form to prepare departmental requests for changes to existing courses.
 This table was created so that you can respond directly in the appropriate column, which will expand to
accommodate responses of any length. You may save and title the file as you wish.
 Please save and utilize this form as a Word document.
 Replace bracketed information with information you supply.
 See “Directions for Completing Existing Course Change Form” for detailed explanations of each item.
Schools/colleges should submit ONE paper copy with ALL REQUIRED SIGNATURES to Academic Affairs (mail
code OAA); in addition please submit via email one electronic copy in Word format (which may be unsigned) to
Steve Harmon in Academic Affairs (harmons@pdx.edu).
College/School
College/School:
Effective term :
(The effective term may be delayed to a later term if the proposal is approved by Faculty Senate after the requested term’s preterm registration has begun, i.e., May for fall/summer, November for winter, and February for spring term.)
1. Type of Request (Change or Drop)
1a.
Change
Type of change (check all that
are appropriate):
____
Course number (2b)____
You must fill in both proposed and
existing information in ALL appropriate
sections.
Changing to/from a 400/500 slash
course (2b)____
Course title (2c) ____
Course description (2e) ____
Credit hours (2f) ____
Lecture hours (2g) ____
Laboratory hours (2g) ____
Course prerequisites (2h) ____
Concurrent enrollment (2i) _____
Co-requisite (2j) _____
Repeatability (2k) _____
Grading option (2l) ____
Other (explain):
1b.
Drop
You must fill in existing
information only.
____
Complete sections 2a.- 2f AND 4a.
2. General Catalog and Banner Information
Existing Information
2a.
Department
Required
2b.
Course prefix and
number
Required
January 201r:OAA:swh
Proposed Information
Page 1 of 5
2c.
Catalog course title
(max 100 chars)
Required
2d.
Banner title (max
30 chars)
Required
2e.
Catalog course
description
(max 50 words –
strictly enforced)
(Include any
expected
preparation if it is to
appear in catalog
description)
Required
2f.
Credit hours:
Required
2g.
Clock hour
distribution:
lecture ____
lecture ____
lab/studio ____
lab/studio ____
____
field work ____
Proposed catalog statement:
Reproduce existing catalog description in full:
field work
online ____
practicum
____
other ______________________
2h.
Course
prerequisite(s):
2i.
Is concurrent
enrollment in the
indicated
prerequisite
permitted?
online ____
practicum ____
other ______________________
No
____
No
____
Yes
____
Yes
____
2j.
Course corequisite:
2k.
Is course
repeatable:
No
____
No
____
Yes
____
Yes
____
If course is
repeatable what is
the limit?
No limit ____ or
No limit ____ or
Maximum of ____ credits or
Maximum of ____ credits or
Maximum of ____ times.
Maximum of ____ times.
Letter only ____
Letter only ____
P/NP only ____
P/NP only ____
Both letter and P/NP ____
Both letter and P/NP ____
undergraduates ____
undergraduates ____
graduates ____
graduates ____
both undergraduates & graduates ____
both undergraduates & graduates ____
doctoral only ____
doctoral only ____
2l.
2m.
2n.
Grading option:
Course intended
for:
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Page 2 of 5
2o.
Teaching method
(identify ONE)
(Used by Registrar
for coding in
Banner.)
lecture ____
lecture ____
seminar ____
seminar ____
experiential ____
experiential ____
activity ____
activity ____
discussion ____
discussion ____
recitation ____
recitation ____
research ____
research ____
lab/studio ____
(See definitions in the Instructions for this
form.)
lab/studio ____
(See definitions in the Instructions for this
form.)
3. Enrollment Projections
3a.
Expected distribution of
enrollment per section
3b.
Students would take this
course as
lower division ____ %
lower division ____ %
upper division ____ %
upper division ____ %
graduate
____ %
graduate
____ %
total
100%
total
100%
check all that apply:
____ a community-based learning course with ______ # of service hours required
(The number of service hours required of the students must be noted.)
(Please note some
additional submissions
may be required related
to specific categories.)
____ a prerequisite for __________
____ a requirement for a major in __________
(A Program Change form must be submitted to add this requirement to the program.)
____ a requirement for a graduate program in ____________________
(A Program Change form must be submitted to add this requirement to the program.)
____ an elective leading to specialization in __________
____ an elective contributing to general or liberal education
____ an elective in a graduate program in ____________________
____ a part of a professional program in __________
____ a part of a licensure or certification program in ____________________
____ a course satisfying UNST Cluster _________________________
(A University Studies cluster proposal must be submitted to the UNST Council.)
4. Rationale
4a.
Reason(s) for the
CHANGE or DROP
4b.
Required
Additional comments
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5. Syllabus (Required for substantive changes to course content or changes to the level of the course)
5a.
A syllabus is required
A Syllabus should include:
with CHANGE proposals  Title
if the changes affect
 Course Prefix and Number
course content or the
 Course description
level of the course
 Prerequisites/co-requisites
 Course Objectives
 Student Learning Outcomes
 Outline of Course Content (major content topic w/ main subdivisions)
 Course requirements (exams, assignments, papers, etc.)
 Required Texts and/or Required Reading List
 Method of Evaluation (letter graded or P/NP and calculation of course grade)
Appropriate distinctions in required coursework and method of evaluation for both
undergraduate and graduate students for an UG/GR slash course.
January 2014:OAA swh
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Signature Page for a Change to Existing Course
Date of
Review
Signature
Role
Name (print)
Course prefix, number and title:____
Proposing
Proposal prepared
by
Dept.
Curriculum
Chair
Dept. Chair
College/School
Curriculum
Chair
Dean
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