INFORMATION CHANGE FORM
#900 _______ ________ _______________________________ ______________________ _______
Student ID Number Last Name First Name MI
□ Major Change: □ Name Change:
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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
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Student Signature Date
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