STUDENT DATA CHANGE FORM

STUDENT DATA CHANGE FORM
Submit any supporting documentation to the Administration Office or upload to this form. The following documents are required to update your student account:

Name Correction – a valid picture ID and one of the following supporting documents: social security card, birth certificate, marriage license, or divorce decree.

Name/Gender Change – a valid picture ID and official court documentation supporting the name/gender change

Social Security Number – valid picture ID and the actual social security card with updated SSN

Date of Birth – valid picture ID or birth certificate showing correct date of birth
Name*
Student ID*
Date of Birth: From

MonthDayYear
Date
To

MonthDayYear
Correct Date of Birth
Gender:
From
To
Correction of Social Security Number:
From
To
Name Change:
From
First and Last Name
To
First and Last Name
Reason for name change

MarriedDivorcedOther
Change of Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Select type of address:

HomeMailing
Change Phone Number to:
Please enter a valid phone number.
Change Email Address to:
example@example.com
Please specify any changes to the following:
Emergency Contact Name

First NameLast Name
Emergency Contact Relationship
Spouse, Parent, Aunt, Friend, etc.
Emergency Contact Phone
File Upload

Upload Supporting Documents Here
Cancelof
Student Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty: