Personal Information Update
Send to: Registrar’s Of ce, DIF #114
Pennsylvania College of Technology
One College Avenue
Williamsport, PA 17701-5799
Or fax to: 570.321.5536
PC 365 4/20
Student ID number ___________________________________ Major _____________________________ Date _______________
Name __________________________________________________________________________________________________________________
Last First Middle
Name Change (please print legibly)
Name ____________________________________________________________________________________________________________
Last First Middle
Are you changing your local address (on- and off-campus housing), or are you changing your permanent
mailing address (home address)?
Change local address Change permanent address
Address Change
Telephone number ______ ___________________________________
Address _____________________________________________________________________________________________________
Street/PO box/Apt. #
__________________________________________________________________________________________________________________________________
City, State, and ZIP Code
County _________________________________________________________________________________
Signature ______________________________________________________________________
College policy protects the rights of privacy and access regarding your educational records as articulated in the Family Educational
Rights and Privacy Act of 1974 (FERPA).
You have the right to inspect your official records. This can be done by making an appointment with the Registrar’s Office.
No one other than you can have access to your records without your written consent unless they are one of the following:
College employees who have a “need-to-know”
Certain government or law enforcement officials in order to carry out lawful functions
Accrediting agencies
Individuals who have obtained subpoenas
Persons who need to know in cases of health and safety emergencies
Information that can be released without your signature is “directory information”. That is your name, address, telephone number, date
and place of birth, electronic email address, major field of study, enrollment status, participation in official recognized activities and
sports, weight and height of member of athletic teams, degrees, honors and awards received, and dates of attendance.
If you do not want “directory information” released to unauthorized person, you must notify the Registrar’s Office
in writing.
STUDENTS: We recommend that you make a copy
of this form, once completed, for your records.
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