Catalog Year Change Acknowledgement – River Valley Community College

Student ID#
Name*
Last First Middle
Email Address*
Telephone #*
Academic Program*
*
- Degree
- Certificate
I have reviewed the current and revised program of study for my academic program listed above.
I have decided to:*
- Stay with the catalog year on my record now
- Follow the revised program of study of the catalog year indicated below
Student Signature*
Date
Date Format: MM slash DD slash YYYY