Request for Change of Major

Completed form should be submitted to the Office of the Registrar, Bennett Davis Hall, Room 112, or mail to Office of the Registrar, University of Pittsburgh at Titusville, Titusville, PA 16354, or Fax to 814-827-5405.

Student's Name:                                                                                                     

ID Number:                                               Social Security #: ______________________________

Previous Major:                                                                                    

Previous Advisor:                                                                                       

NEW PROGRAM (please check one):

                   Certificate                         Associate's degree                     Bachelor's degree

New Major:                                                                 

New Advisor:                                                               

Student's Signature:                                                                    Date: