Western Illinois University, School of Graduate Studies



Required Approval Signatures

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|Department Chairperson |_________________________________ |Date: ___________ |

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|College Dean |_________________________________ |Date: ___________ |

Submit Completed Form to Office of the Provost and Academic Vice President

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|Academic VP Received |_________________________________ |Date: ___________ |

Department:      

Program Title:      

|Current program requirements: |Proposed program requirements: |

|Enter current program requirements here |Enter proposed program requirements here |

Rationale for change: (Include how annual student learning assessment activities and the University Mission influenced this request, if applicable.)

     

Does the change involve another department’s course offerings?

No Yes (Attach communication from other department indicating concerns or objections, if any.)

Effective Date:      

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