One College Drive
Calais, ME 04619
Enrollment & Student Services 207-454-1013
Instate: 800-210-6932
Fax: 207-454-1018
Non-Discrimination Policy
: Washington County Community College is an equal opportunity/affirmative action institution and
employer. For more information; please call Tatiana Osmond, Affirmative Action Officer, at 454-1094.
RE Form Address Name Change Notify: IT Office
Revised: July 8, 2019; amd Business Office
Financial Aid Office
Address/Name Change
Student ID #: ________________ Program of Study: ________________________________________
Name at the beginning of the academic year:
Last Name: __________________________ First Name: _________________________ M.I.: _______
Change name to:
Last Name: __________________________ First Name: _________________________ M.I.: _______
Name change documentation:
Marriage License Court Document
Provide original and a copy will be attached to this form.
Once your name is changed in our computer system, your computer/portal login
and your WCCC email address will change.
Mailing Address: _____________________________________________________________________
City: ________________________________________ State: _____________ Zip: ________________
Phone Number: ___________________________ Cell Phone Number: __________________________
Cell phone carrier: US Cellular Verizon AT & T Tracfone Other __________ Text Updates: Yes No
Personal email address: ________________________________________________________________
Not your WCCC email address.
Please submit completed form with documentation to Donna Geel, Assistant to the Academic Dean.
Student Signature: _________________________________________________Date:______________
For Office Use Only
Documentation attached
Processed: __________________ __________________
Initials Date
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