Change Of Student Information Form
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Change of Student Information Form
Information must be printed or typed in black or blue ink. (Penciled forms will not be accepted.)
Student name and ID (Required)
Name: ______________________________________________________________________
Last
First
Middle
Student ID number: ____________________________________________________________
Change of Address (if requesting in-district tuition, Request for In-District Residency
Form must be completed)
New Address: ________________________________________________________________
Street Address
City
State
Zip
□
□
□
Public School District for New Address:
Crawford County R-1 (Bourbon)
New Haven
St. Clair R-
□
□
□
□
□
□
13
Sullivan C-2
Union R-11
Washington
Franklin Co. R-2
Lonedell R-14
Spring Bluff R-15
□
□
Strain-Japan R-16
Other (specify district & city) _________________________________________
Old Address: ________________________________________________________________
Street Address
City
State
Zip
New Phone Number: (_____) ___________________________________________________
New Business Number: (_____) _________________________________________________
New Cell Number: (_____) ____________________________________________________
E-mail: _____________________________________________________________________
Name Change Request (Must provide proof of legal name change)
New Name: ______________________________________________________________
Last
First
Middle
Former Name: ____________________________________________________________
Last
First
Middle
Student Signature (Required): _________________________________ Date: ___________
Updated 8/22/14 SSC
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Parent category: Business