Please Print Clearly:
Name: ______________________________________________________________ Date: _______________
Last First Middle
Student or Colleague ID#: __________________ Birthdate: _______________________________________
Please Change Danville Area Community College records to reflect my new/corrected:
Address (Go to Box A) Name (Go to Box B) Social Security Number (Go to Box C)
Danville Area Community College
Address, Name, Social Security Number Change Form
Admissions & Records (Students): 217.443.8800
Human Resources (Employees): 217.443.8757
2000 E. Main Street
Danville, IL 61832
Box A: Address Change
New Address:
______________________________________________________ __________________________
Street Address Telephone
_________________________________ _________________ __________________________
City State Zip
Box B: Name Change
Legal Documentation required: A driver’s license or picture ID and an updated social security card. A change of name must be
completed with the Social Security Administration prior to changing a name with Danville Area Community College.
Employees: New W4’s are also required for a name change.
Former Name New Name
____________________________________ ____________________________________________
Last First Middle Last First Middle
Box C: Social Security Number Change
If your social security number is incorrect, you must provide a signed social security card as well as a photo
ID. Please bring a photo ID and social security card to the Admissions Office (for students) or the Human
Resources Office (for employees). Court orders are required for legal social security number changes.
Former/Incorrect Social Security Number New/Corrected Social Security Number:
_________________________________________ _____________________________________