Office of the 
Registrar 



Shuster Hall, Room 102 

250 Bedford Park Boulevard West 
Bronx, New York 10468 

P (718) 960-8255 

F (718) 960-7336 

www.lehman.edu/registrar





Declaration of Academic Plan and Sub-Plan 




This is an application to request to modify your current Academic Plan/Sub-Plan. 




Student Information – please print clearly 

EMPLID 

D.O.B. 
/ 
/ 


Last Name 
First Name Middle Initial 


Phone ( ) 
__________ 

Email @LC.CUNY.EDU 

















NEW UNDERGRADUATE PROGRAM: To be completed by your Advisor 


BA BS BFA BBA BA/MA BA/MS CERT 




MAJOR Plan 
Sub-Plan 




Number of credits required: as per Undergraduate Bulletin dated to 





Is this a change of major? 

YES NO 

Is this a second major? 

YES NO 



Special Requirements (if any): 








Signature of Advisor Date 



MINOR Plan 
Sub-Plan 



Number of credits required: as per Undergraduate Bulletin dated to 




Is this a change of minor? 


YES NO 

Is this a second minor? 

YES NO 



Special Requirements (if any): 






Signature of Advisor Date 



 SIGNATURE REQUIRED BELOW 



I certify the information on this application is accurate and complete and will be treated confidentially for institutional purposes only. I understand by signing this form that: I have 
made the decision to change my degree requirements by changing my Academic Curriculum Plan, I know the program requirements, and understand that I must complete the 
program(s) requirements according to the rules and regulations listed in the current undergraduate bulletin. 





/ / 


Student Signature Date 



Return this completed form to: 












Office of the Registrar 

Shuster Hall, Room 102 

04/2017