This plain text version of the Graduate Change of Program Request form is 
being provided for accessibility purposes and is not to be used for 
submission.  Please print and fill out the formatted forms provided.
  
THE UNIVERSITY OF TEXAS AT DALLAS
INTERDEPARTMENTAL GRADUATE CHANGE OF PROGRAM REQUEST

Name 
	Last:   
	First:
	Middle Initial:
    	
Student ID number:

Mailing Address
	Street:
	City:
	State:
	ZIP/Postal Code:

E-mail Address:
Work Phone:
Home Phone:

STUDENTS MUST MEET WITH AN ADVISOR PRIOR TO REQUESTING PROGRAM CHANGES.

My Current degree program is
	Department:
	Degree:
	Major:
					        

I wish to change my graduate program to: (Check One)

ARTS AND HUMANITIES	
___MA, HUAS			
___MA, HUHI			
___MA, HUMA			
___MA, HUSL				
___MAT, HUAS	
___MAT, HUHI	
___MAT, HUMA	
___MAT, HUSL	
				
COMPUTER SCIENCE
___MS, CS		
___MS, SE		

ENGINEERING		
___MSEE, EE		
___MSEE, EEM	
___MSEE, EET	
			
MATHEMATICS
___MS, EGM 
___MS, MAP	
___MS, MATH 
___MS, STAT 

PHYSICS		
___MS, APHY	
___MS, PHY	

SOCIAL SCIENCE
___MA, ASOC		
___MS, ASOC

MANAGEMENT 		
___MA, IMS	
___MBA, MBA	
___MS, AIM		
___MS, MAS		
___MBA, MITM

MIMS
___ESM, MA, MIMS
___ESM, MBA, MBA
	
Project Management 
___ESM, MBA, MBA	
___ESM, MS, MSPM


With few exceptions you are entitled, on your request, to be informed 
about the information U.T. Dallas collects about you.  Under Sections 
552.021 and 552.023 of the Texas Government Code, you are entitled to 
receive and review the information.  Under Section 559.004 of the Texas 
Government Code, you are entitled to have U.T. Dallas correct information 
about you that is held by us and is incorrect.   Be assured that your UTD 
records are protected from unauthorized disclosure by federal law.

Your Social security number (SSN) or UTD Identification number is being 
requested because it is a unique identification number that is maintained 
for the purpose of assurance that the correct student record is being 
updated, for tracking purposes and for state and federal report 
requirements.  The disclosure of such information is voluntary. 
Disclosure of your social security number or UTD identification number is 
governed by the Public Information Act (Chapter 552 of the Texas 
Government Code).

I have read and understand the information imparted on this form.

Student's Signature

Date

Advisor's Signature

Date

ATTENTION INTERNATIONAL STUDENTS:
What is your current immigration status? ___________  Has this status 
changed since you last applied to UTD? ___________ (If yes, please provide 
updated copies of your immigration documents to the International Student 
Services Office)

If you currently hold an F-1 or J-1 status, you must receive an I20 or 
IAP66 for your new major within 15 days of the beginning of your new term. 
You must bring a bank statement and financial affidavit to the 
International Student Services Office within 15 days in order to maintain 
your immigration status.

Date

Student Signature


(7/16/03)