PERSONAL INFORMATION UPDATE
Office Use Only:
B: _____________________
Admit Year:_____________
Received by:_____________
Received Date:__________
Student ID Verified________
EFSC Student ID Number:
B
Current Name: Last
(Please print)
First _____________________________________Middle_________________________________
Student
: Please check the appropriate section(s) and complete. Please print legibly using blue or black ink.
Photo ID must
accompany this form if mailed, faxed or emailed.
NAME
(Required documentation: driver license or social security card)
Note: If you are a current Eastern Florida employee (e.g. student worker) you must submit your name change through Human
Resources. They will require a copy of your updated social security card.
First_____________________________________Middle________________________________________
Last
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________ _____________________ ___________ ____________ _________ _________________ _________________ ________ _________ _________ ________ ____ _____ ________ _________ _________________ ___________ _____________________ _________________ _________________ ________ _________ _________ _________________________________________________________________________
ADDRESS, PHONE NUMBER, AND/OR EMAIL ADDRESS
Check all that apply: Mailing Address Financial Aid Address
Street _______________________________________City____________________ State___________
Zip Code____________ Phone (_____)__________________ Email____________________________
EMERGENCY CONTACT INFORMATION
Name ___________________________________
Street __________________________City_________________ State_____ Zip Code_____________
Relationship
Phone ( )
SOCIAL SECURITY NUMBER
(Required documentation: social security card)
DATE OF BIRTH (Required documentation: driver license,
birth certificate or other legal document) (dd/mm/yyyy)
American Indian or Alaskan Native
Native Hawaiian or Other Pacific Islander
White Black
CITIZENSHIP
(Required documentation: see Admissions for list of approved documents)
US Citizen Permanent Resident Alien
Non-Immigrant Visa Holder
International Student (F-1)
Undocumented Alien
Other:__________________________
I certify that the above information is accurate and complete to the best of my knowledge.
Student Signature: Date:________________________
FOR OFFICE USE ONLY Check GUASYST to determine if student is designated as employee and/or vendor. If yes, update
student record and send copy of this form and legal document to HR and/or Accounting for review.
Name: ____SPAIDEN ____SPACMNT ____SOAHOLD ____SAAACKL ____GUASYST
MA Address: ____SPAIDEN ____SOAHOLD ____SPACMNT ____GUASYST
Emerg. Info: ____SPAIDEN ____ SOAFOLK
SC-088 R012215
click to sign
signature
click to edit
![]()
