Name: __________________________________________ Date: __________________________
Student I.D. Number: _________________________________________________________________
Current Major (4-Letter Code): ______ ______ ______ ______
New Major Name: ___________________________________________________________________
New Major (4-Letter Code): ______ ______ ______ ______
Type of Degree (Please Circle One): ASA AES AAS AA AS Certificate
Advisor Signature: ___________________________________________________________________
Student Signature: ___________________________________________________________________
Please Return this Form to the Admissions/Registration Office in Vermilion Hall
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