PLO STATEMENT CHANGE FORM

Date:	[Click here and select date from the drop-down arrow]
Division/Program:	Click here to enter Division & Program Name.
Contact Person:	Click here to enter Contact Person.
Existing PLO No(s). [Enter in box below]	Existing PLO Statement(s) [Enter in box below]
Click here to enter PLO number(s) being changed. Put a space in between each PLO statement, if more than one is changing.	Click here to enter the current PLO Statement that is being changed. Put a space in between each PLO statement, if more than one is changing.
PLO No(s). / PLO Title(s) [Enter in box below]	REVISED PLO Statement(s) [Enter in box below]	REVISED PLO Assessment Timelines (Semester & Year)	PLO-to-ILO Alignment
Click here to enter the PLO number(s) being changed and the REVISED/NEW PLO Title. Put a space in between each PLO No. & Title, if more than one PLO statement is changing.	Click here to enter REVISED/NEW PLO Statement. Put a space in between each PLO Statement, if more than one PLO statement is changing.	Click here to enter the Assessment Timelines for each PLO that has changed). Enter at least 2 semesters for each PLO.	Click here to enter the ILO number(s) that each revised PLO statement aligns with. (Even if it has not changed.)
Faculty Consulted:	Click here to enter name(s) of faculty members consulted.
CCC Consulted:	Click here to enter name(s) of College Curriculum Committee consulted.
Facilitator Approval:	Click here to Division Facilitator name.	Approval Date:	Click here and select date from the drop-down arrow.
Coordinator Approval:	Click here to enter SLO/PLO Coordinator name.	Approval Date:	Click here and select date from the drop-down arrow.
Dean’s Approval:	Click here to enter Dean or Associate Dean’s name.	Approval Date:	Click here and select date from the drop-down arrow.
This Section For PLO Admin Use Only:
Revised PLO Title and Statement entered in TracDat: YES ☐ NO ☐	Date entered in TracDat:	Click here and select date from the drop-down arrow
Revised PLO Status marked “Active” in TracDat: YES ☐ NO ☐	Revised Assessment Timelines entered in TracDat: YES ☐ NO ☐
Revised PLO Input Date entered in TracDat (Input Date is same as Dean’s Approval of Revised PLO Statement): YES ☐ NO ☐
Revised PLO Statements & Alignments revised in Alignment Grid: Statements YES ☐ NO ☐ Alignments (If Applicable): YES ☐ NO ☐
Alignment Grid Revision Date:	Click here and select date from the drop-down arrow
Old PLO Statement re-numbered with preceding “0”: YES ☐ NO ☐
Old PLO Status marked ‘Inactive’ in TracDat: YES ☐ NO ☐
Old PLO Inactive Date entered in TracDat (Inactive Date is same as Dean’s Approval of Revised PLO Statement): YES ☐ NO ☐
Old PLO Statement moved to bottom of PLO list YES ☐ NO ☐