Fillable FillableChangeofStudentInformation031419MA CHANGE of STUDENT RECORD INFORMATION

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FillableChangeofStudentInformation031419MA CHANGE of STUDENT RECORD INFORMATION

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File type: PDF

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CHANGE of Student Record Information
Provide your name and SCCID# “as they currently appear” on your SCC student records
Last First MI SCC ID
Telephone # ___________________ Date of Birth: _______
Please check √ each item you wish to change & print/type those changes in the spaces provided:
1. Name - Change to: Last First MI
2. Social Security Number* - Change to: ↓
↓
*A SSN change requires that you include a copy of your SSN card for verification along with this form.
3. Address - Change to:
Street City/State/Zip Code
4. Email Address – Change to:
5. Telephone Number – Change to:
(
)
6. Date of Birth – Change to: / /
7. ( ) Verified I.D.
__________ Initials
__________ Date
K12 to Grad or
Grad to K12
For Office Use Only:
Student Signature Date By: ____ Date: _________
A&R_03.14.2019 MA
-
RESET FORM
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FillableChangeofStudentInformation031419MA CHANGE of STUDENT RECORD INFORMATION

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Completed 4 March 2020

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