Change in Graduate Curriculum 


Application for requesting to change the academic curriculum plan/certificate program plan, and/or addition of a second certificate or extension 
program to the current curriculum plan. 


Student Information – please print clearly 


EMPLID __________________________________________ D.O.B._______/_______/_____________ 
 

Last Name ______________________________________________ First Name _________________________________________ Middle Initial _________ 


Phone ( _____________ ) ______________ --- _____________________ Email_________________________________________________@LC.CUNY.EDU 

 

CURRENT GRADUATE PROGRAM 

 
MA MAT MFA MPH MS MSED MSW ADV. CERT. 

 
Current Program Name (Academic Plan) ________________________________________


Current Advisor (Full Printed Name)  _________________________________________

 
Current Advisor (Signature)   ________________________________________________         Date ______________ 

 


NEW GRADUATE PROGRAM: Complete this section only if you intend to change your current graduate program. 

 
MA MAT MFA MPH MS MSED MSW ADV. CERT. 

 
New Program Name (Academic Plan) ______________________________________________


New Advisor (Full Printed Name)  ______________________________________________

 
Additional admissions materials needed (Circle One): 

N/A     Letter(s) of Recommendation*        Statement of Purpose*         Proof of Prior Certification(s)* 

 
Current Advisor (Signature) __________________________       Date  ___________________ 

 

Graduate Studies Director (Signature)  _______________________     Date  ____________________ 

 



ADD CERTIFICATE OR EXTENSION PROGRAM: Complete only if you wish to add a certificate or extension to your academic plan of study. 


Certificate or Extension Program Name (Academic Plan) ______________________________________


Certificate or Extension Advisor (Full Printed Name) _______________________________________

 

Certificate or Extension Program Advisor (Academic Plan) ___________________________________    Date ___________ 

 

I certify that the information on this application is accurate and complete and will be treated confidentially for institutional purpose only. I understand by signing this 
form that: I have made the decision to change my degree requirements by changing my Program of Study (Academic Curriculum Plan), I know the program 
requirements, I understand that I must complete the program(s) according to the rules and regulations listed in the current graduate bulletin of Lehman College, and I 
am responsible for notifying the Office of International Student Services about the curriculum change if I hold an F-1 visa. I also understand that if I choose to apply for 
state certification while still active in my current program(s) I am required to adhere to the specific department guidelines for admissions, complete all state 
requirements, and be enrolled in or completing final curriculum requirements before filing for graduation. 



Student Print Full Name _____________________________________________



Student Signature ___________________________________________________		Date ________________

 

Return this completed form to: 

Office of the Registrar 

Shuster Hall, Room 102 

 


FOR OFFICE USE ONLY 

RECEIVED BY/ DATE: _________________________ 

FOLDER: Y N 

PROCESSED BY/ DATE:_______________________ 

ADM: FRSH TRNS GRAD 

EFF. TERM: FA SP SU 

START TERM: FA SP _________