Office of Admissions and Student Records
Revised 10/2014 Address: 601 E. College Drive, P.O. Box 270 Winnebago, Nebraska 68071 Phone: 402.878.3307 Fax: 402.878.2309 Website: www.littlepriest.edu
Change of Student Information
Student Name ____________________________________ ID Number: ____________
Previous address ___________________________________________
City, State, ZIP __________________________________________
Email address ____________________________________________
Please make the following change(s) on my records:
Date of change: ____________________________________________
Change of Information:
__________________________________________________________
Street, Box #, RR
____________________________________________________________________
City State Zip
Phone Number: _____________________________________________
Cell Phone Number: _________________________________________________
I hereby certify the above statements are true.
__________________________________________
Signature
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