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DATA INFORMATION CHANGE (Garden City Community College)

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The DATA INFORMATION CHANGE (Garden City Community College) form is 1 page long and contains:

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Country of origin: US
File type: PDF

U.S.A. forms for Garden City Community College

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DATA INFORMATION CHANGE
Name ____________________________________ Date ____________________________
(before change)
GCCC I.D. No. __________ EFFECTIVE DATE OF ADDRESS CHANGE ______________________
______ Birthdate*
______ Residency*
______ Classication
______ Marital Status
______ Spouse Name
______ Other
______ Social Security No.*
______ Last Name*
______ First Name*
______ Middle Initial
______ E-mail Address
TYPE OF CHANGE:
(*requires hard copy verication attached to this form)
Change From: ________________________________________________________________________________
Change To: ________________________________________________________________________________
Source/Reason: ________________________________________________________________________________
Signature ___________________________________________________
Date change entered ___________
(Registrar’s Ofce)
This form must be forwarded to the Registrar's Ofce
______ HOME/PERM Address & Phone #
______ CURRENT Address & Phone #
______ Mail Preferred (choose one):
HOME/PERM Address
CURRENT Address
______ Gender/Ethnicity
DATA INFORMATION CHANGE
Name ____________________________________
(before change)
Date ____________________ GCCC I.D. No. _____________________
DATE OF ADDRESS CHANGE ________________________________
______ Birthdate*
______ Residency*
______ Classication
______ Marital Status
______ Spouse Name
______ Other
______ Social Security No.*
______ Last Name*
______ First Name*
______ Middle Initial
______ E-mail Address
TYPE OF CHANGE:
(*requires hard copy verication attached to this form)
Change From: ________________________________________________________________________________
Change To: ________________________________________________________________________________
Source/Reason: ________________________________________________________________________________
Signature ___________________________________________________
Date change entered ___________
(Registrar’s Ofce)
This form must be forwarded to the Registrar's Ofce
______ HOME/PERM Address & Phone #
______ CURRENT Address & Phone #
______ Mail Preferred (circle one):
HOME/PERM Address
CURRENT Address
______ Gender/Ethnicity
FOR OFFICE USE ONLY
Routing:
Admissions
Cashier
Endowment
Admissions
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Completed 3 February 2021

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