INTENT TO OFFER AN EXISTING DEGREE PROGRAM BY DISTANCE LEARNING

Institution:	Choose an item.

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

Program title(s) as it appears on Academic Program Inventory, Diploma, and Transcript:	Click or tap here to enter text.
Degree(s) awarded:	Click or tap here to enter text.
Six-digit CIP code, IHL sequence code:	Click or tap here to enter text.
Total credit-hour requirement:	Click or tap here to enter text.

Cost to offer by distance learning:	Click or tap here to enter text.
Responsible academic unit:	Click or tap here to enter text.
Institutional contact: Phone: Email:	Click or tap here to enter text.

List any institutions within the State offering similar programs:	Click or tap here to enter text.

Can this program be completed entirely online?	☐Yes	☐No
Will this program require separate admission from those offered on campus?	☐Yes	☐No

Number of students enrolled in last 5 years:	Number of graduates in last 5 years:
Year 1	Click or tap here to enter text.	Year 1	Click or tap here to enter text.
Year 2	Click or tap here to enter text.	Year 2	Click or tap here to enter text.
Year 3	Click or tap here to enter text.	Year 3	Click or tap here to enter text.
Year 4	Click or tap here to enter text.	Year 4	Click or tap here to enter text.
Year 5	Click or tap here to enter text.	Year 5	Click or tap here to enter text.
Total	Click or tap here to enter text.	Total	Click or tap here to enter text.

Program Summary:
Click or tap here to enter text.

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