Request Change of Status

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Before completing this form, review Program Requirements and course in the Pathways College Catalog. The Pathways College Catalog can be found on the website pathwayscollege.org.

First and Last Name *

Date of Request *

YYYY

Phone Number *

Reason for change of student status: *

Academic Load

Personal

Medical/Health

Financial

Expulsion

Academic deficiencies

Schedule conflict

Transferring major

Program does not fit needs

Military Deployment

Other

I am requesting to withdrawal from the following program:

Bachelor of Arts in Business Administration

Bachelor of Arts in Liberal Studies

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I am requesting to enroll in the following program:

Bachelor of Arts in Business Administration

Bachelor of Arts in Liberal Studies

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Please give a short explanation for why you are submitting this request. *

Please read, check, and submit: *

By checking this box and submitting this form, I am agreeing that I am signed in to Pathwayscollege.org as myself and that all the information on this form is correct.

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Approved by (Printed): _____________________________

Title: _____________________________________________

Signature: ________________________________________

Date:_________________________

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