Application for Associates in Technical Studies Degree

Submit to the Office of the Dean of Instruction

Student:

Date Submitted:

Counselor and /or Faculty Sponsors:

Degree Title:

List Career Objectives. (Jobs for which the degree will prepare the applicant.)

List Employers or Business/Industry Consultants

List pertinent information related to short-term and/or long-term need for someone with this training.

List program competencies to be achieved.

Courses Needed to Complete the Degree

General Education Courses

List specific general education courses to be completed as part of the degree.

Minimum 15 credits Consult the latest UHMC catalog for more information.

Please indicate courses completed or in process before the date of this application.

English (3 credits minimum)Alpha/Number Title

Completed In Progress Planned

Mathematics (3 credits minimum)Alpha/Number Title

Completed In Progress Planned

Social Science (3 credits minimum Alpha/Number Title

Completed In Progress Planned

Humanities (3 credits minimum)Alpha/Number Title

Completed In Progress Planned

Natural Science (3 credits minimum) Alpha/Number Title

Completed In Progress Planned

Program and Elective Courses

List specific courses to be completed as part of the degree.

Minimum 45 credits.

Please indicate courses completed or in process before the date of this application.

Alpha/Number Title

Completed In Progress Planned

Alpha/Number Title

Completed In Progress Planned

Alpha/Number Title

Completed In Progress Planned

Alpha/Number Title

Completed In Progress Planned

Alpha/Number Title

Completed In Progress Planned

Alpha/Number Title

Completed In Progress Planned

Alpha/Number Title

Completed In Progress Planned

Alpha/Number Title

Completed In Progress Planned

Alpha/Number Title

Completed In Progress Planned

Alpha/Number Title

Completed In Progress Planned

Alpha/Number Title

Completed In Progress Planned

Alpha/Number Title

Completed In Progress Planned

Alpha/Number Title

Completed In Progress Planned

Alpha/Number Title

Completed In Progress Planned

Alpha/Number Title

Completed In Progress Planned

Alpha/Number Title

Completed In Progress Planned

Alpha/Number Title

Completed In Progress Planned

Alpha/Number Title

Completed In Progress Planned

Alpha/Number Title

Completed In Progress Planned

Alpha/Number Title

Completed In Progress Planned

Course selection may be altered with the approval of sponsor(s) based on course availability and time restraints.

Respectfully Submitted

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Student Date

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Program Coordinator / Counselor Date

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Program Coordinator / Counselor Date

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Additional Program Coordinator / Counselor Date

Reviewers: (UHMC campus) Signature Page

1. Recommendation: Approval Non Approval

Comments

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Allied Health Department Chair Date

2. Recommendation: Approval Non Approval

Comments

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Business/Hospitality Department Chair Date

3. Recommendation: Approval Non Approval

Comments

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English Department Chair Date

4. Recommendation: Approval Non Approval

Comments

______

Humanities Department Chair Date

5. Recommendation: Approval Non Approval

Comments

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Social Sciences Department Chair Date

6. Recommendation: Approval Non Approval

Comments

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Science Technology Engineering Mathematics Department Chair Date

7. Recommend: Approval Non Approval

Comments

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Vocational Technical Department Chair Date

8. Approved Not Approved

Comments

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Vice-Chancellor of Academic Affairs Date

Approved original copy to: Main Sponsor

Copies to: Vice-Chancellor of Academic Affairs, Applicant, Additional Sponsor(s), Curriculum Committee Chair

Revised February 2009/bkg