Change In Student Information Form printable pdf download

CHANGE IN STUDENT INFORMATION

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

Last

First

Middle

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 ___________________________________________

__________________________________________________

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

Change In Student Information Form

Related Articles

Related forms

Related Categories