Name _________________________________ Telephone _____________________

Address ________________________ City/Zip _____________________________

E-mail address __________________________________

Title of Major_____________________________________________________________

________________________________________________________________________

Type of degree (Bachelor of Arts or Bachelor of Sciences)_____________________

______GPA for all college work completed.

______Number of units completed toward graduation as of the end of the most recently completed semester.

______Total number of units undertaken during the current semester.

______Number of G.E. units remaining to be completed as of the end of the current semester.

I hereby certify that this application has been submitted in completed form by the deadline.

____________________________ ________________________

ITDS Coordinator Date application was received

________________________

Submission deadline

I.	LIST OF COURSES. The courses must total a minimum of 45 units.
	Core courses (24-26 Upper Division units only, including ITDS 499 [3 units])

Institution	Dept.	Course #	Title	Units	Semester/Year to be taken	Grade

	Supporting courses (the remaining Upper and Lower Division units)
Institution		Dept.	Course #	Title	Units	Semester/Year to be taken	Grade

Please attach forms for all Special Studies (495) and Internships.

II.	ADVISORS' SIGNATURES

To the Chair of the Advisory Committee: Would you please briefly comment on this proposal with respect to the criteria listed below.

•The clarity with which the subject or topic is described.

•The interdisciplinary character of the subject and the balance of courses between disciplines.

•A convincing justification of the courses with reference to the program’s subject and title.

•The strength of the proposal as a degree program.

•The likelihood that the applicant can complete the program. Consider both your knowledge of the applicant’s motivation and academic skills and the probability that the courses needed for the program will be offered within a reasonable period of time.

	A.	Chair
			____________________________   Print name				____________________________   Signature
			____________________________   Department/Program				____________________________   Date

Chair’s statement (continue on reverse side if necessary):

	B.	Other member
			____________________________   Print name				____________________________   Signature
			____________________________   Department/Program				____________________________   Date

III.	STUDENT'S SIGNATURE

I acknowledge that the Special Major consists of a minimum of 45 units of course work, of which 31 units must remain to be completed at the time this proposal is approved.* I understand that work-in-progress during the semester of my proposal's approval will count towards these units. I also understand that my submission of this application does not in any way imply that the application is approved or that I have been admitted as a Special Major.

________________________________ _______

rev. May, 1997 Student's signature Date

*except where an exception has been granted by the ITDS Committee (see p. 6 of Guidelines)