Fillable Merced College Name/Address Change Form (Merced College)

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Merced College Name/Address Change Form (Merced College)

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The Merced College Name/Address Change Form (Merced College) form is 1 page long and contains:

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  • 19 other fields

Country of origin: US
File type: PDF

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Merced College
Name/Address Change Form
MC Form-1210; Rev. February 2018
Last Name (Currently on file – OLD name)
First Name (Currently on file – OLD name)
Student/Employee ID #
NOTE: Name changes require a copy of your Social Security card.
NAME CHANGE SECTION ONLY. If no name change skip this area. Only write the name to be changed in this box.
New Last Name
New First Name
New Middle Name
Text Approved
New Home (Physical) Address (No P.O. Box)
Primary Phone Number
Text Approved
City
State
Zip
Secondary Phone Number
* By checking Text Approved I authorize text messages to be sent and
accept responsibility for any charges that result.
New Mailing Address (If different than above)
City
State
Zip
Office Use ONLY
Employee
Personal Email Change
*Merced College Student Emails will not be changed*
Only one personal email will be on file
New Email
Email to Remove
Signature
Date
Merced College
Name/Address Change Form
MC Form-1210; Rev. February 2018
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Merced College NameAddress Change Form (Merced College)

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Completed 5 September 2020

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