PHONE CHANGE
SOCIAL SECURITY CHANGE
NAME CHANGE
Houston Community College
CHANGE OF NAME, ADDRESS, PHONE, & SOCIAL SECURITY NO.
CHANGE OF: (CHECK ALL APPROPRIATE)
NAME PHONE ADDRESS *SOCIAL SECURITY NO.
*TO BE MADE ONLY BY REGISTRAR’S OFFICE
DATE OF BIRTH
ADDRESS CHANGE
NEW HOME ADDRESS
NO. STREET APT. NO. CITY STATE ZIP
I
N WHAT SCHOOL DISTRICT DO YOU RESIDE?
HISD STAFFORD ALIEF KATY
CY-FAIR SPRING BRANCH FORT BEND NORTH FOREST OTHER ___________
NEW MAILING ADDRESS
NO. STREET APT. NO. CITY STATE ZIP
* If your new address changes your residency status, you must complete Change of Residency petition and submit supporting
documentation.
E-MAIL ADDRESS
NEW HOME PHONE
DATE ENTERED
SIGNATURE DATE
With few exceptions, state law gives you the right to request, receive, review and correct information about yourself collected on this form.
FORM NO. 400 (REV.8/16 PRINT2438)
LAST FIRST M.I.MO DAY YEAR.
STUDENT I.D. DATE OF BIRTH
NAME
LAST FIRST M.I. LAST FIRST M.I.
NEW NAME
PREVIOUS NAME
INCORRECT S.S. NO.
CORRECT S.S. NO.
NEW EMERGENCY PHONE
(AREA CODE)
(AREA CODE) (EXTENSION
08152016.PRINT2438.ChangeNameAddress_form.pdf 1 8/16/16 9:51 AM
click to sign
signature
click to edit
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