Fillable Enrollment Services NAME CHANGE / ADDRESS CHANGE / (Montgomery County Community College)

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Enrollment Services NAME CHANGE / ADDRESS CHANGE / (Montgomery County Community College)

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U.S.A. forms for Montgomery County Community College

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Enrollment Services
Email: enrollmentservices@mc3.edu
FAX: 215-619-7188
NAME CHANGE / ADDRESS CHANGE / RESIDENCY CHECKLIST
Please complete, print, and return the below form to the Enrollment Services Office.
First Name
Last Name
Student ID#
Last 4 digits of SS#
Is this ? Name Change
Address Change
Both Name and Address Change
Mailing Address Update Only
New Name or Address
Name
New Home Address
Address (Line 2)
City
State
ZIP Code
Township
Preferred Phone
Phone Type Cell Home Work
Secondary Phone
Phone Type Cell Home Work
E-mail
NOTE: NAME CHANGES AFFECT LOGINS; THEREFORE, LOGINS MUST BE UPDATED WHEN NAME CHANGES ARE MADE
Residency Information
I have moved to: Montgomery County Remain In-County
Outside the County Outside the State
Instructions
1. Student must provide proof of current residency by presenting a copy of one of the below documents listed in Item A.
2. Proof of date residency was established may be documented by providing one form of proof from Item B.
Note: A student may challenge his/her residency classification by completing the Residency Appeal Form
. If he/she is not satisfied
with the decision made, the student may file a written appeal with the Executive Director of Enrollment Services (MCCC, 340 DeKalb
Pike, Blue Bell, PA 19422). The decision of the Executive Director of Enrollment Services on the challenge is final.
A. Proof of Residency within PA
and Montgomery County
PA Driver's License or address update card with current address.
PA State Identification Card showing address.
B: Proof of Date of residency if
different from Item A (Optional)
Lease papers or document of sale for a permanent, independent
residence at stated address.
Copy of a vehicle registration card with the new address.
Voter Registration Card
Permanent Residency Card, Refugee Card, or Application to Adjust
Status to Permanent Resident (I-485), plus one proof of current
residence.
Effective Date of Change
Statement of Intention to Reside Indefinitely
Please read and sign the below statement:
I intend to reside at the address indicated as current on the front of this form for at least one year. I have provided this information
and certify it to be true and correct. If the information given is proven to be incorrect, I acknowledge that I will be subject to re-billing
at the out of county/out of state rate.
Signature: __________________________________________________
Date: ______________________________________________________
Office Use Only
Processed by: _________________ Date ___________
Copies of Required Documentation Attached? ______ Yes ______ No
County Code/Township Code in Colleague: ________________
Commonwealth Residency and County Residency
§ 35.29b. Commonwealth of PA Residency- To establish Commonwealth residency, you must demonstrate continuous residence in the Commonwealth for a
period of twelve (12) months prior to registration as a student.
County Residency
All residents of Montgomery County are eligible for the in-county sponsored tuition rate. In order to be considered a resident, you must demonstrate continuous
residence in Montgomery County for a period of six (6) months prior to registration as a student.
Please note:
• Establishing an address for the purpose of attending college does not establish domicile.
• The proof for establishing residency or a change of residence rests with the student.
Cases are decided on the basis of facts submitted by the student, with determination based on the subjective intention of the student to reside indefinitely in the
Commonwealth. A student may challenge his/her residency classification by completing the Residency Appeal Form. If he/she is not satisfied with the decision
made, the student may file a written appeal with the Executive Director of Enrollment Services (MCCC, 340 DeKalb Pike, Blue Bell, PA 19422). The decision of
the Executive Director of Enrollment Services on the challenge is final.
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Enrollment Services NAME CHANGE ADDRESS CHANGE (Montgomery County Community College)

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Completed 3 October 2020

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