Change of Information Request

Online Student Records / Change of Information Form

Name changes require:

One piece of valid photo identification with current name AND
A copy of an official name change document.

Valid photo identification: passport, government issued ID, valid Driver’s License, etc. Official name change document: divorce decree, marriage license, immigration documents, etc. Social Security Number changes must include a copy of the signed Social Security card. Instructions for providing documents will be provided after submitting this form.

Use this form to change/add the following information (check all that apply): (Required)

Name

Address / Phone

Social Security Number

Previous Information

Last Name (Required)

First Name (Required)

Middle (Required)

Address (Required)

City (Required)

State (Required)

Zip Code (Required)

Date of Birth (Required)

Preferred Name

Student ID # (Required)

Phone Number (Required)

Previous SSN#

New Information

Last Name

First Name

Middle

Address

City

State

Zip Code

Date of Birth

Preferred Name

Student ID #

Phone Number

New SSN#

Username (Required)

Password (Required)

Student Sugnature (Type your full name) (Required)

Date (Required)

Change of Information Request

Online Student Records / Change of Information Form

Previous Information

New Information

CONTACT INFORMATION