Student Information Change Form
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Complete Student Information Change Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
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9
STUDENT INFORMATION CHANGE
Student ID
Last Name
First Name
Middle Name
Signature
Date
Change Name (Photo ID required) (PSU Employees: Bring updated Social Security card to Human Resources)
New:
Last
First
Middle
Former:
Last
First
Middle
Reason(s) for name change (check all that apply):
□
□
Marital Status
Naturalization or Citizenship (Documentation required)
□
□
Spelling Correction
Legal Name Change (Documentation required)
Change Address or Phone Number (International Students: The address must be where you currently reside; it cannot be a post office box.)
New Address: ____________________________________________________________________________________________________________
Mailing Address
_____________________________________________________________________________(_______)_______________________
City
State
Zip Code
Phone
Change Email Address New: ______________________________________________________________________________________
Major, Minor, Pre-Professional Track and Certificate Update
□
Change major/minor/pre-professional track/certificate
List Program(s): _____________________________________________________________________________________
□
Add a major/minor/pre-professional track/certificate
List Program(s): _____________________________________________________________________________________
□
Remove major/minor/pre-professional track/certificate
List Program(s): _____________________________________________________________________________________
Rev. 10/08 – Registration | student info change.doc
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Parent category: Business