Academic Affairs

Sample Form PC for Requesting Two Changes

PROGRAM CHANGE FORM

1. Submitted by: University of Missouri-St. Louis

Name of Institution (campus or off-campus residential center in the case of multi-campus institutions.)

2. Type of Program Change (Check those that apply):

_____ Title change only

_____ Combination program created out of closely allied existing baccalaureate program

__X__ Option(s) added to existing program(s)

_____ Addition of certificate program developed from approved associate degree

_____ Addition of free-standing single semester certificate program

_____ Delete program(s)

_____ Delete option(s)

__X__ Program placed on "Inactive Status"

3. Indicate Program Change or Addition of Options:

Changed From:

Title of Former Program/Certificate Option

Degree

CIP Code

Changed To:

Title of New Program/Certificate Option

Degree

CIP Code

Counseling with options in

(1) General Counseling(2) Elementary

(3) Secondary

MED

131101

Counseling with options in

(1)General Counseling
(place general counseling option on inactive status)(2) Elementary(3) Secondary

(4)Community Counseling (add as new option area)

MED

131101

4. Attach a copy of the "before and after" curriculum as applicable and a rationale for the proposed change.

5. Intended date of program change, additional options, or "Inactive Status":

August 2004

Month/Year

AUTHORIZATION

Stephen Lehmkuhle

Vice President for Academic Affairs

Name/Title of Institutional Officer Signature Date

Stephen Lehmkuhle

Vice President for Academic Affairs 573-882-6396

Person to Contact for More Information Telephone Number