Student Information Update Form
Name Currently on File
*
First Name
Last Name
New Name (if applicable)
First Name
Last Name
Must provide supporting documentation for above name change (Photo ID, Social Security Card, Marriage License/Divorce Decree, etc)
*
Browse Files
Cancel
of
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mobile Phone
*
-
Area Code
Phone Number
Alternate Phone Number (if applicable)
-
Area Code
Phone Number
Personal Email
*
example@example.com
When would you like this information update to be effective?
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Disclosure
LAW - The Privacy Act of 1974, the contents of this document contains privileged or other confidential information. Unauthorized disclosure may result in civil and criminal sanctions. If you are not the intended recipient, or believe you have received this communication in error, do not reproduce, retransmit, disseminate, or otherwise use this information.
IMU Contact Information
229 Peachtree Street, Suite 700 (International Tower) Atlanta, GA 30303 P: 404-881-1916 | F: 404-881-1897 | www.imu.edu
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