CHANGE OF STATUS
Please complete this form by indicating your goal as a graduate student at Eastern Illinois University and print it. Return this form to the Graduate School Office, Eastern Illinois University, 600 Lincoln Ave., Charleston, IL 61920 or fax it to: 217-581-6020. Remember that in order for you to be considered for degree candidacy, the appropriate entrance exam scores (if required) must be on file in the Graduate School Office.

Name: EIU E #:
Previous names (if applicable):
Street or PO Box:
City: State: Zip: Phone # :
E-Mail Address:

I was admitted in (year) to take graduate courses at EIU pursuing:

Graduate Degree

Degree:

Major:

Non-Degree (not pursuing a degree)
Teacher's Certification Only Field:

Second Bachelor's Degree

Degree:

Major:

Certificate Programs:

Certificate in Work Performance Improvement

 Certificate in Computer Technology

Certificate in Quality Systems

Certificate in Technology Security
 Certificate in Reading Instruction  Certificate in Accountancy  

I wish to change my status to pursue:
Degree:
MA / Major:
MBA / Major: Business Administration
MS/ Major:
EDS/ Major: Educational Administration ( Specialist)
MSED/ Major:
SSP/ Major: School Psychology

Non-Degree (not pursuing a degree)
Teacher's Certification only/ Field:
Second Bachelor's Degree / Degree: Major:

Certificate Programs:

Certificate in Work Performance Improvement

  

Certificate in Computer Technology

Certificate in Quality Systems

 Certificate in Technology Security
 Certificate in Reading Instruction  Certificate in Accountancy  
List completed graduate degrees at EIU (for example, MA-History, 2006):

Effective semester for change:


Signature:___________________________________________________ Date: