Student Change Request Form

Student Change Request Form

First (Preferred) Name*

Last Name*

Email Address*

Program Start Date*

You can find this on your dashboard if you are unsure.

What is your program of study? Check all courses that apply.*

Select or enter value

Please select the type of change you need:*

NOTE: If you drop a specialty, you lose the time that was allocated to complete that specialty, i.e., the time to complete the Canvas course AND the time to complete the Clinical component. Your expected graduation date will be adjusted accordingly, which may result in the need to purchase an extension(s).

NOTE: If you are requesting a refund or to withdraw from the program, you must include a comment stating the reason.

Select

Course(s)/Program Component(s) in change request:*

Select

Date Course or Program Expires*

Select the date the course/program expires (see Student Dashboard in Canvas - "speedometer" icon under the profile/account icon).

Requests submitted after course/program expiration will not be approved. See "Policies" here: https://www.nursing.emory.edu/pages/woc-traditional-pathway#Content-Section-5

Extension Duration*

Select or enter value

Comments (Optional):

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