Blackfeet Community College
Change of Information Form
Name:
*
First Name
Middle Name
Last Name
Student ID:
*
Email
*
example@example.com
Please check all that apply:
*
Change of major
Change of name (must provide social security card that reflects this change)
Change of phone number
Change of advisor
Change of address (specify change to be made)
I am requesting that the following information be changed from:
*
To be recorded as:
*
Student Signature
*
Clear
Date
*
-
Month
-
Day
Year
Date
Advisor Signature
*
Clear
Date
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: