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:

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