Name/Address Change Form
MC Form-1210; Rev. February 2018
Last Name (Currently on file – OLD name)
First Name (Currently on file – OLD name)
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 Home (Physical) Address (No P.O. Box)
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)
*Merced College Student Emails will not be changed*
Only one personal email will be on file