CSCC Change of Information Form
Student Name: ______________________________________
Cougar ID: __________________________________________
Please mark and complete the section(s) you are requesting to be updated and include your name and Cougar ID number on all attachments.
Contact Information Update
Address: Street: __________________________________________________________ Apt Number: __________
City: ________________________________________ State: _______________ Zip Code: ____________
Would you like to receive texts from CSCC regarding important information? ____Yes
Cell Number and Provider is required for texts:
Cell Phone Number: ___________________________ Cell Phone Company/Provider: _______________________
Secondary email: _______________________________________________________________________________
NOTE: Your Columbus State student.cscc.edu email will always be primary.
Emergency Contact Name: _____________________________________________ Phone Number: ___________________
Name Changes/Corrections – your name change could result in a change to your Columbus State username.
Visit password.cscc.edu in 24-48 hours to discover your updated username.
Current Name on File: _________________________________________________________________
(First, Middle, Last)
New Name: __________________________________________________________________________
(Please print clearly) (First, Middle, Last)
Reason for change:
___ Correction to Name
Documentation required: current/valid government issued photo ID with full name.
___ Name Change due to Marriage, Divorce, or Legal Name Change
Documentation required: current/valid government issued photo ID .
AND a copy of associated document that verifies the name change, such as marriage license, divorce decree, or
court order of legal name change.
Social Security Number Correction: ___________________________________________
Documentation required: Current/valid government issued photo ID, and copy of signed Social Security Card.
Selective Service Number: ___________________________________________________
Date of Birth Correction: __________/_________/_________
Documentation required: Current/valid government issued photo ID with full name and date of birth.
Submit this completed form and all required documentation to email@example.com or to Student Central/Student
Services (addresses above). If you have questions, contact us at 614-287-5353.
By signing I certify that all the information reported is complete and correct.
Student Signature (Required) Date