Registrar Forms

All forms listed on this page are in Microsoft Word format.

Add/Drop Form

Dropping or adding courses must be completed in accordance with the designated time periods as published in the Academic Calendar. An official Add/Drop Form must be signed by the student and by the student's academic advisor. Forms are available in the Registrar's Office.

Change of Major Form

Currently enrolled students who are requesting a change of major must first submit the Change of Major Request Form to the department they are exiting. After the exiting Program Director signs the form, the student must submit it to the Program Director of the desired program of entry. The student's file will be reviewed in a timely manner and a decision letter will be mailed to the student.  Forms are available from department secretaries or can be downloaded here.

Declaration of a Minor Form

Click here to download the Declaration of a Minor Form (Word document).

Diploma Replacement Form

A replacement diploma may be ordered by submitting the Diploma Replacement Form to the Registrar’s Office. The form is available from the Registrar’s Office or can be downloaded from this site.  The charge is $60.00 payable to Jefferson College of Health Sciences is due upon ordering.   The turn-around time is approximately 6-8 weeks. 

Documentation to Take Courses Elsewhere Form

Click on the link below to download a form in Word documenting course work that you intend to take at another institution.

Dual Major Application Form

Click on the link below to download the Dual Major Application Form (Word document).

Graduation Applications

It is the student's responsibility to submit an Application for Graduation two academic sessions prior to the session in which the student expects to complete curriculum and college requirements for graduation. A copy of the form is available in the Registrar's Office or can be downloaded from this site.

Incomplete Request Form

An “Incomplete” will only be granted in documented circumstances beyond the student’s control that prevent the student from completing the course requirements on time. The student must have already successfully completed the majority of the coursework (over75%) with a course average of “C” or above. The student must complete all work before the Last Day to Drop with a “W” in the term immediately following term in which the “I” was issued (excluding summer).

Independent Study Form

Independent Study courses may be offered by certain departments to permit the student to independently investigate specific courses or areas of interest. The Independent Study Course Contract Form is available in the Registrar's office or from this site and must be signed by the student, instructor, the program director, and by the Dean of Academic and Student Services. Formal approval for any independent study course must be granted by the end of the "Add" period of the semester in which the course is taken.

Leave of Absence Request Form

Click on the link below to download a Leave of Absence Request Form in Word.

Letter of Recommendation Authorization Form

Click on the link below to download a Letter of recommendation Authorization Form in Word.

Personal Information Changes Form

Currently enrolled students and alumni should remember to update the college with all name/address/phone number changes. Such changes should be submitted to the Registrar on the Personal Information Changes Form.  

Registration Override Request Form for the Registrar's Office

  1. An override request from a student should first be reviewed by the student advisor.
  2. If the advisor believes the request is warranted he should complete and sign this request form then submit it to the program director for approval and signature.
  3. The form containing both advisor's and program director's signatures should be submitted to the registrar to process.

Report Request Process and Form

Click on the link below to download a Report Request Form in Excel.

Request for Administrative Withdrawal

Students wishing to withdraw from a class after the final withdrawal date (the last date to withdraw with a "W") must complete a request for administrative withdrawal, which is only authorized by the Dean for Academic Affairs for extenuating circumstances.

Tuition is not reimbursed with an administrative withdrawal. Students are encouraged to consult the Bursar’s Office at (540) 985-3585 and the Office of Financial Aid at (540) 985-8267 to determine the financial implications of their withdrawal.

The student must submit a request for administrative withdrawal in writing to the Dean for Academic Affairs. The request must be placed on the official form available below. The form must be supplemented by additional documentation.

The request must:

  • identify circumstances beyond the student's control that have occurred after the final drop date (date must be specified) and prevent successful completion of the course. If such circumstances occurred prior to the final drop date, the request must also document the extenuating circumstances leading to a failure to drop the course before the final drop date. Lack of awareness of the final drop date is not considered an extenuating circumstance.
  • include documentation verifying all extenuating circumstances. Examples of acceptable documentation include a letter from a physician, lawyer, counselor, or other professional.
  • indicate the last day of class attendance or online activity in a distance course.
  • be accompanied by a letter/e-mail from instructors of all courses involved in the request indicating their recommendation regarding the request.

The Dean will respond within five business days of receipt of the student's letter and written recommendation from all involved instructors. A written copy of this decision will be sent to the student with copies to the registrar, course instructors and advisor. The decision of the Dean is final.

Second Degree Application Form

Click on the link below to download the Second Degree Application Form (Word document).

Student Exit Form for Withdrawal from the College

The Student Exit Form verifies that the student has met all academic requirements and financial obligations to the college before graduation. The form can be downloaded here or can be found in the Registrar's Office. Beginning two weeks prior to Commencement, any senior planning to graduate must submit a completed Student Exit Form to the Registrar after obtaining all required signatures as listed on the form. The deadline to submit the form to the Registrar is the last official day of classes prior to graduation.

Transcript Requests

Jefferson College of Health Sciences now offers electronic, paper mailed and paper pickup transcripts through our new online transcript ordering system. We recommend that you do not access the system using a handheld device such as a smartphone or tablet, as some functionality may not work properly. Learn more by clicking here.