Updated January, 2015
Continuing Education
Change of Information Form
Student Name
Student ID Phone
Directions
This form is used to change your Name, Address, and/or Contact Information. You may type directly on this form,
then print it out for your signature and submission. Your HCC record will be updated within two business days.
1) Complete only the information that needs to be changed
2) Print the form
3) Sign and date the form
4) Submit form by fax, U.S. mail, or in person (this completed form will not be accepted through email)
Howard Community College
Office of Continuing Education
10901 Little Patuxent Parkway
Columbia, MD 21044
Fax: 443-518-4333 | Hickory Ridge Room 100
NAME CHANGE
Name on Record: Last First Middle
New Name: Last First Middle
ADDRESS CHANGE* (Do Not list a PO Box)
Street Apt./Unit #
City State Zip Code County
*Address changes will not update residency status. Students requesting a change in residency status must also fill out an Application for
Change of Residency Status available at www.howardcc.edu/rrvaforms
CONTACT INFORMATION CHANGE
Cell Phone
Home Phone
Business Phone
Preferred Email Address Secondary Email Address:
I certify that all the information I have provided is true and complete and that changing my permanent address may affect my residency
status and tuition rate. I understand that failure to provide accurate information and falsification of identity can lead to legal action and
college sanctions, including dismissal from the college, and/or retroactive adjustment of tuition. I agree to provide additional documents
upon request to verify the information submitted on this form.
Student Signature Date
Office Use
Staff ______________________
Date ______________________
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