A & R DEMOGRAPHICS AND MAJOR CHANGE FORM
Instructions: Bring this form, along with student ID and a current photo identification to the Admissions and Records office
DATE SUBMITTED: _______________________
Check all the boxes that apply:
Name Change
Phone Number
Address
Email
Major / Academic Program
CURRENT INFORMATION
Student ID or Last 4 SSN:
Last Name:
First Name:
Middle Initial:
INFORMATION TO CHANGE
Fill in only the information you wish to change
Student ID or Last 4 SSN:
Last Name:
First Name:
Middle Initial:
Phone Number:
Email:
FOR OFFICE USE ONLY:
2.16.16 SSC