Change of Name / Address

Use this form to change your name and/or address. Complete the appropriate information, certify that the information provided is complete and accurate, then submit.
* denotes required field

Student ID:	Please do not enter your Social Security Number.

Current Information

*Name:	First: Middle: Last:
*Street:
*City/State/Zip:
County:
*Phone Number:	( ) - -
Email:

New Information

*Name:	First: Middle: Last:
*Street:
*City/State/Zip:
County:
*Phone Number:	( ) - -
Email:

Type of Change

Permanent Temporary

By clicking on the Submit button at the bottom and checking this box, you certify that all information provided is true and complete to the best of your knowledge. You also understand that submission of false information may be sufficient for the College to cancel your enrollment and require withdrawal.