Change of Status Form

Name Name * First Last
Are you an international student? *

Are you an international student? Yes No
Date Date / MM / DD YYYY
EIU E# *
Previous Names (If Applicable)
Address Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Number Phone Number * - ### - ### ####
E-mail Address *
Admission Information
Year Admitted to Take Graduate Courses at EIU *
I Applied or Was Admitted to Pursue the Following Type of Degree: *
If You Chose Graduate Degree, Teacher's Certification, or Second Bachelor's Degree, Please List the Degree and Major or Certification Field:
If You Chose Certificate Program, Please Specify Which Program You Entered:
New Status Information
I am Updating My Status to: *

I am Updating My Status to: Add a program Change programs
The Change or Addition is: *
If You Chose Teacher's Certification or Second Bachelor's Degree, Please Specify the Field of Your Desired Degree and Major or Certification:

This field is required for everyone except non-degree and certificate program-seeking students.
If You Chose Certificate Program, Please Specify the Program You Wish to Enter:
List Completed Graduate Degrees at EIU (For Example, MA-History, 2006): *
Effective Semester for Change *
Any additional information you would like to share: