Change of Name or Address Form

Change of Name or Address Form

Please only complete the sections of this form that are marked as required, and the section for the information that you are wanting to update with the Admissions Office. It is not necessary to complete the entire form unless you are wanting to update all of your contact information.
Panola College Student ID Number*
Panola College Student Email Address*
example@example.com
Semester Enrolled*
(Fall, Spring, Summer I, Summer II)
Change of Legal Name

Complete this section if you would like to update your legal name (after marriage, divorce, or adoption)
Current Name

First NameLast Name
Previous Name

First NameLast Name
Please upload your supporting documentation for this name change

Supporting documentation can include: A picture of your State Issued Identification Card, Marriage License, Divorce Decree, or any other government issued documentation.
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Change of Address

Complete this section if you would like to update your Mailing or Physical Address
Physical Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
PROOF OF RESIDENCY ONLY - If you are completing this address change to support a Residency Status Change, attach your supporting documentation using this drop box.

Supporting documentation for "Proof of Residency" are the following: Tax receipts, Drivers License/ID card, Lease Agreement, Texas High School Transcript, Employer statement of date of employment, and Texas Voter Registration Card. (YOU MUST SUBMIT TWO SUPPORTING DOCUMENTS AND THEY MUST BE AT LEAST A YEAR OLD)
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Change of Phone Number

Complete this section if you would like to update your Phone Number
Telephone No.
Change of Emergency Contact

Complete this section if you would like to update your Emergency Contact
Emergency Contact Name

First NameLast Name
Emergency Contact Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Phone
Relationship to Student
Change of Email Address

Complete this section if you would like to update your contact email address, this is to update your personal email account on file, not your Panola College Student Email Address
Email
example@example.com
Date*

MonthDayYear
Date
Students authorization signature*

Clear
Panola College is an Equal Opportunity Institution that provides educational and employment opportunities on the basis of merit and without discrimination because of race, color, religion, sex, age, national origin, veteran status, disability, or genetic information.
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Change of Name or Address Form

Change of Legal Name

Change of Address

Change of Phone Number

Change of Emergency Contact

Change of Email Address