Request Request to CIP No. of Total Total to Deactivate Clock Credit Program Name/Code Code Weeks Activate Hours Hours (Enter Yes (Enter Yes Below) Below) Total Total Request Request to CIP No. of to Deactivate Clock Credit Program Name/Code Code Weeks Activate Hours Hours (Enter Yes (Enter Yes Below) Below) Request Request to Total Total CIP No. of to Deactivate Clock Credit Program Name/Code Code Weeks Activate Hours Hours (Enter Yes (Enter Yes Below) Below) Request Request to Total Total CIP No. of to Deactivate Clock Credit Program Name/Code Code Weeks Activate Hours Hours (Enter Yes (Enter Yes Below) Below) Requested by (Print Name): Date: Dean/Department Chair (Print Name): Dean/Department Chair (Signature): Date: Please complete and return this form to the Financial Aid Office, Attention: Financial Aid Director, Tony Rand Student Center-Room 119.
Program Name/Code CIP Code No. of Weeks Total Clock Hours Total Credit Hours Request to Activate (Enter Yes Below) Request to Deactivate (Enter Yes Below) Program Name/Code CIP Code No. of Weeks Total Clock Hours Total Credit Hours Request to Activate (Enter Yes Below) Request to Deactivate (Enter Yes Below) Program Name/Code CIP Code No. of Weeks Total Clock Hours Total Credit Hours Request to Activate (Enter Yes Below) Request to Deactivate (Enter Yes Below) Program Name/Code CIP Code No. of Weeks Total Clock Hours Total Credit Hours Request to Activate (Enter Yes Below) Request to Deactivate (Enter Yes Below) Requested by (Print Name): Date: Dean/Department Chair (Print Name): Dean/Department Chair (Signature): Date: Please complete and return this form to the Financial Aid Office, Attention: Financial Aid Director, Tony Rand Student Center-Room 119.