Address Update
and Name Change Form
Student Name: ____________________________________________ GCID: 911-________________________
Complete only the sections of this form that need to be updated.
Sign the form and submit it to the Registrar’s Office, Parks Hall 107, CBX 069, or 478-445-1914 (fax).
Please update my mailing (local) address. Please update my permanent (home) address.
Street: ______________________________________ Street: ______________________________________
City, State, Zip ________________________________ City, State, Zip _______________________________
Phone Number: (___________) __________________ Phone Number: (___________) _________________
Please update my parent/guardian address(es).
Parent Name ________________________________ Parent Name ________________________________
Street: ______________________________________ Street: ______________________________________
City, State, Zip _______________________________ City, State, Zip _______________________________
Phone Number: (___________) _________________ Phone Number: (___________) _________________
Email ______________________________________ Email ______________________________________
I have applied for graduation. Please change the address where my diploma will be mailed.
Street: _______________________________________________________________________________________
City, State, Zip ________________________________________________________________________________
Please change my name.
From: _______________________________________________________________________________________
To: _________________________________________________________________________________________
All name change requests must include legal documentation, such as a marriage license, divorce decree, or court order. If you are a graduation
candidate and want to have this new name listed on your diploma when it is issued, please initial here: _________________________
If you are requesting a new email address as part of your name change, please initial here: _________________________________
Please list this as my preferred first name on my records:
Name: _______________________________________________________________________________________
Student Signature: __________________________________________ Date: ______________________
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signature
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