Change of Information Request
Instructions: To change your major, add or delete a minor, or to change your student directory information, complete
this form and return it to the Enrollment Office in Student Services.
Mail: Montgomery Community College Email: housleyt@montgomery.edu
Enrollment Office Fax: 910.576.2176
1011 Page Street Campus delivery: Building 100, Student Services
Troy, NC 27371
MCC Student ID Number or Social Security Number
Name (as it appears on current records)
Last First Middle Initial
Change major to Certificate Diploma Degree
Add minor Certificate Diploma Degree
Delete minor Certificate Diploma Degree
Change program to day evening
* Documentation (Social Security card, driver’s license, marriage license, etc.)
must be provided before a name change will be processed.
* Change name to
Last First Middle Initial
Change address to
PO Box/Route/Street City State ZIP Code
Change phone number to (home) ; (work)
Student’s Signature Date
SS012517
> > > > > > > FOR STUDENT SERVICES USE ONLY < < < < < < <
Reviewed/Approved by Enrollment Office
Enrollment Specialist Date
Enrollment Coordinator Date
Changes Processed
name; documentation
major from
to
added minor:
address
term from
to
deleted minor:
phone number
advisor from
to
institutional change
program to day evening
goal from
to
Changed in Colleague Date
Comments:
Evaluation completed Date
click to sign
signature
click to edit
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome