Change of Status Form

Which program are you currently enrolled in?*
- Full-time / Degree Program
- Short-term or Continuing Education Program
Full-time / Degree Program Course Information
Select the Full-time Program*
Short-term / Continuing Education Course Information
Select the Short-term or Continuing Education Program*

Who is completing the form?*
First Last
Reason for status change*
- Leave of Absence
- Withdraw from Program
- Change of Program/Level
- Add/Drop a Course
Course Name
Explanation of status change*
Current Class Enrolled*
Effective Date of Change*
MM slash DD slash YYYY
Phone number a representative can reach you at*
Best time to call*
I acknowledge I have discussed my change of status with my instructor, advisor, and/or success coach.*
- Yes
I acknowledge I have discussed my change of status with financial aid and the business office and understand how this change may impact me financially.*
- Yes
Comments
This field is for validation purposes and should be left unchanged.

Your Information