INTENT TO OFFER MODIFY OR DELETE A CERTIFICATE PROGRAM

Institution:	Choose an item.

Date of anticipated implementation:	Click or tap to enter a date.

Notification of intent to:	☐Offer a certificate ☐Modify an existing certificate ☐Delete a certificate

Certificate title as it will appear on Academic Program Inventory:	Click or tap here to enter text.
Six-digit CIP code (and four-digit IHL sequence code if this is a modification or deletion):	Click or tap here to enter text.
Total credit hours:	Click or tap here to enter text.
Unit head: Phone: Email:	Click or tap here to enter text.

OFFERING or MODIFYING a certificate - Complete this section if the intent is to offer or modify a certificate.
Vocational certificate:	☐Yes	☐No
Credit-bearing program:	☐Yes	☐No
Title IV financial aid eligible:	☐Yes	☐No
Which of the following best describes this certificate program?
☐	Pre-Baccalaureate (Less than 1 Year) - Undergraduate program with duration of less than one academic year; designed for completion in less than 30 credit hours
☐	Pre-Baccalaureate (At Least 1 Year) - Undergraduate program with duration of at least 1 year; designed for completion in at least 30 hours; does not meet requirements for associate or bachelor’s degrees
☐	Post-Baccalaureate - Program designed beyond the baccalaureate degree but does not meet the requirements for a master’s degree
☐	Post-Master’s - Program designed beyond the master’s degree but does not meet the requirements for a doctoral degree
☐	Other - Other certificate program not meeting one of the four criteria above
Program summary:
Click or tap here to enter text.

Chief Academic Officer Signature – Date	Institutional Executive Officer Signature – Date