FORMJ

CERTIFICATE OR LICENSURE PROGRAMPROPOSAL

Department:
Contact Person:
Email: / Phone:
Date:

Please use bold for responses and place (X) where appropriate.

1. Program Title:
2. Degree program that certificate is derived from:
3. Required Credit Hours: ___
4. Level:
( ) PB Post-Baccalaureate Certificate
( ) PM Post-Master’s Certificate
( ) LP Licensure Program (post-baccalaureate)
5. 6-digit CIP Code: / SpecialtyCode: / 000
(If you know thespecialtycode,thenpleasereplace"000"withthecorrectvalue. Otherwise,pleaseleave"000" as thedefaultvalue.) Approved CIP Codes for UNCG can be found on the UNC-GA Degree Finder
6. Certificate Program only: Do you plan to pursue and complywithGainfulEmployment regulationsforstudent financialaid eligibility?
( ) Yes ( ) No
7. Requested Start Term:
8. RationaleforOfferingProgram: Provide a complete explanation for the requested change. Additionally,pleaseincluderationaleforprogramlength/ number of credithours, includingreferencesto externalprofessionalstandards,accreditation requirements,etc.,ifapplicable.
9. Student Learning Objectives (SLOs), including rationale:
10. For Whom Planned:
11. Admission Requirements: (Provide an explanation if no admissions test is required.):
12. ProgramRequirements:
13. Bulletin Text:
14. The proposed certificate or licensure program is a:
( ) brand new program
( ) new mode of delivery that is offered in addition to an existing program
( ) new mode of delivery that replaces an existing program
If replacing,how willstudents enrolled (current, incoming, and 2+ if applicable) be allowedto completetheircourseof study?
15. Mode of Delivery (Place an (X) for all applicable modes of delivery):
( ) on campus
( ) 100% online Delivered: ( ) synchronous ( ) asynchronous ( ) both
( ) Hybrid % of program online:_ %_ Delivered: ( ) synchronous ( ) asynchronous ( ) both
( ) off-campus (include complete street address):__
16. Consultation withotherdepartments(AttachForm B: Course/Program Consultations)
17. Attach the completed Signature Sheet for FormJ (see next page).

SIGNATURE SHEET

CERTIFICATE OR LICENSURE PROGRAMPROPOSAL

Requests will not be considered without the appropriate signatures.

Department:
Program Title:
Contact Person:

Please Sign and Print Name in the Following Order

1
Dean of Academic Unit / Date
2
Chair,DepartmentCurriculumCommittee(ifapplicable)or DepartmentHead / Date
3
Chair,AcademicUnit(College/SchoolCurriculumCommittee) / Date
4
AssociateDeanfor Academic Affairs andStudentServices intheSchoolof Education
(If applicable for teacher licensure) / Date
Approval by UCC and/or GSC
The requested action has been approved through UNCG’s internal curricular processes.
This change is found to be within the scope of the mission of The University of North Carolina at Greensboro.
DATE APPROVED / Chair,GraduateStudies Committee
DATE APPROVED / Chair,Undergraduate Curriculum Committee

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