Change In Student Information Form


This form is for current students who are changing their name, address, or major
Social Security No. ________________________________
Date of Birth __________________________
Name __________________________________________________________________ ‫ ڤ‬Check if this is a change of name
Student’s Signature _____________________________________
Date __________________
Complete this section for Change of Address/Phone Number:
New address: Date you moved (month/day/year): ___________
Prior to that I lived at:
Address ___________________________________________
Address ___________________________________________
County ___________________________________________
County ___________________________________________
Telephone No. (home) ______________________________
Telephone No. (work) ________________________________
Telephone No. (cell)
E-mail address
If you have changed your county of residence, you must complete the following:
I provide the following facts about my residency and agree to furnish evidence for verification upon the request of a
designated college official:
I live on property that I own: ‫ ڤ‬Yes ‫ ڤ‬No
I live on property that I rent: ‫ ڤ‬Yes ‫ ڤ‬No
I live substantially all year at the address given: ‫ ڤ‬Yes ‫ ڤ‬No
All, or substantially all, of my possessions are maintained at the address given: ‫ ڤ‬Yes ‫ ڤ‬No
I have filed a Maryland income tax form on all of my income: ‫ڤ‬Yes ‫ ڤ‬No
I am registered to vote in the precinct for the address given: ‫ ڤ‬Yes ‫ ڤ‬No
I am licensed to drive: ‫ ڤ‬Yes ‫ ڤ‬No If yes, provide: Driver’s License Number:___________________________ State:____________
License Plate Number:_____________________ State:___________
I have received more than one-half of my financial support from another person during the most recently completed calendar year:
‫ڤ‬Yes ‫ڤ‬No If yes, provide: Name:_____________________________________Relationship:____________________________
Complete this section for Change of Major/Catalog Year/Advisor:
Present Major ______________________________________
Proposed Major _____________________________________
‫ ڤ‬Change of catalog year to 20_____ - 20_____
‫ ڤ‬Change of advisor to ________________________________
Is Above Present Major a Second Major? ________________
Is Above Proposed Major a Second Major? ________________
‫ ڤ‬I have received transfer credits. Please re-evaluate my transcripts for my proposed new major.
For Office Use Only
Recorded by _________________
Date ____________
Change Residency To__________
Effective _________
New advisor _____________________________________
Dir. Of Adm. Sign.: _______________ Date: __________
Note: Date of record is the date the signed form is received by the student services office.
Rev. 8/14


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Parent category: Business