Change of Name/Address
Current Legal Name _________________________________________________________________ ______
Preferred Name _______________________________________________________________________
Student ID Number _________________________________________ Date of Birth _________________
COMPLETE ALL THAT APPLIES:
Name Change
- Requires a copy of the legal document for change (i.e. marriage certificate or court order)
Previous Name _______________________________________________________________________
First Middle Last
Current Marital Status: Single Married
Address/Phone Number Change
New Address ________________________________________________________________________
____________________________________________________________________________________
City State Zip Code County
Phone Numbers Home _________________________________
Cell ___________________________________
Work __________________________________
Student signature ___________________________________________ Date _________________________
Please return completed form to the Records Office
710 Colegate Drive, Marietta, Ohio 45750
Fax: 740-568-1965
Email: recordsoffice@wscc.edu
Office Use: Updated in Colleague by __________ Date ___________
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signature
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