1. EDUCATIONAL PROGRAM CHANGE Request Form
(Use for program proposal, significant modification of program [three or more changes],
or for deletion of program)
Deadline for Submission for 2013-14 catalog: March 15, 2013
Date: __________________ Title of request: _________________
(Provide a three- to four-word description of request.)
Educational Program __________________________________________________________
Department/School ____________________________________________________________
College ______________________________________________________________________
Change Requested (Check all that apply)
Educational Program Name
Modification of an Existing Educational Program
Educational Program Retained as Minor – Attached Curriculum
Educational Program Not Retained as Minor
Significant modification (more than two courses), attachments provided:
current curriculum – educational program
proposed curriculum – educational program
student learning outcomes – educational program
Replacement of an Educational Program
If yes, which program? __________________________
New Educational Program
Statement of Need - Attached
New Program Proposal:
Curriculum Attached
Student Learning Outcomes Attached
Deletion of Educational Program
Educational Program Curriculum - Attached
Educational Program Review – Attached
Change Relevant and/or Needed to Support QEP? If yes, explain._______________________
_____________________________________________________________________________
DU Educational Program Change Form Page 1 Office of Academic Affairs
Last modified 2/2011
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2. Change Relevant and/or Needed to Support Compliance with Accreditation Standards? If yes,
explain._______________________________________________________________________
Abstract of Proposed Program (if new or significantly changed):
Student Learning Outcomes
Rationale for Request
Current Status (Check all that apply) Status with Change
Program Includes Course in Core
 Program Includes Requirement of Another Major
Meets All SACS, Educational Program Criteria
Program Enjoys Additional Accreditation Status
If yes, which agency? _______________
ANTICIPATED IMPACT of Requested Change(s)?
None Yes (If yes, explain.)
Accreditation implication_________________________________________
Budget ___________________________________________________________
Instructional support (faculty) _________________________________________
Instructional space __________________________________________________
Effect on other academic programs _____________________________________
Cross-listed with other course(s) - Which College (s)?______________________
Current prerequisite for other course(s) __________________________________
Proposed prerequisite for other course(s) ________________________________
Duplicates existing course ____________________________________________
REVIEW/APPROVAL: Name /Signature Date
Review within College
DU Educational Program Change Form Page 2 Office of Academic Affairs
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3. Coordinator, Educational Program_________________________________________ _____
Chair, Department/School________________________________________________ _____
Chair, Curriculum Committee, College ___________________________________ _____
Dean, College _______________________________________________________ _____
Review External to College Signature Date
If Cross-Listed Course, Dean - Second College ______________________________ _____
Chair, University Curriculum Committee __________________________________ _____
Faculty Senate, President ______________________________________________ _____
Faculty General Assembly, President _____________________________________ _____
Provost and Senior Vice President for Academic Affairs _______________________ _____
Senior Cabinet, President _______________________________________________ _____
Board of Trustees, President _____________________________________________ _____
Dean, Records/Registration ____________________ Change(s) Made:__ Date Recorded: ____
Note to Department/School and College Curriculum Committee
Both a complete, signed hard copy and digital copy along with a curriculum checksheet
must be submitted one week PRIOR to the meeting of the University Curriculum Committee.
DU Educational Program Change Form Page 3 Office of Academic Affairs
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4. Please submit to the Chair, University Curriculum Committee.
DU Educational Program Change Form Page 4 Office of Academic Affairs
Last modified 2/2011
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