INFORMATION CHANGE FORM
#900 _______ ________ _______________________________ ______________________ _______
Student ID Number Last Name First Name MI
Major Change: Name Change:
_____________________ ______________________ __________________ __________________ _____
Major Code Description Last Name Frist Name MI
Address Change: Mailing (if your mailing address is a PO Box, you must provide a legal permanent address)
______________________________ ________________ _________ ______________ (_____) ___________
Street Address City State Zip Code Telephone Number
Address Change: Legal Permanent Address
______________________________ ________________ _________ ______________ (_____) _________
Street Address City State Zip Code Telephone Number
______________________ Add FERPA Release Remove FERPA Release AVC Employee
Birth Date
_______________________________ ___________________
Student Signature Date
Office Use Only
_____________________ ____________
Processed By Date
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome