Student Change of Information

Name*

First Name

Last Name

FC ID#*

Which pieces of information do you wish to change? (Select all that apply)*

Address or Phone Number Changes Work / Business Address or Phone Number Changes Financial Responsibility Changes Other Changes (Name, Social Security #, Marital Status, etc.)

Section A

Section A: Address or Phone Number Changes

Which change do you wish to make?*

Address Change Phone Number Change

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

This address is my*

Permanent address Local address

Phone Number*

The information in Section A is appropriate for all of the following*

Myself Both Parents Custodial Parent Non-custodial Parent Emergency Contact Billing Information Other (Please specify)

Section B

Section B: Work / Business Address or Phone Number Changes

Business Name*

Which change do you wish to make?*

Address Change Phone Number Change

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Phone Number*

The information in Section B is appropriate for all of the following*

Myself Employment of custodial mother Employment of custodial father Employment of custodial stepmother Employment of custodial stepfather Billing Information Other (Please specify)

Section C

Section C: Financial Responsibility Changes

Change to*

Myself Custodial Parent Non-custodial Parent Other (Please specify)

Name*

First Name

Last Name

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Phone Number*

Section D

Section D: Other Changes (Name, Social Security #, Marital Status, etc.)

Type of Change*

New Information*

I understand that the information provided herein will be used to update my records in the student information system throughout campus. I hereby authorize these updates and take full responsibility for any inaccuracies.

Student Change of Information Form