101 College Parkway Arnold, Maryland 21012-1895
Records and Registration Office / SSVC 140
410-777-2243 / Fax 410-777-2489 / records@aacc.edu
Please print clearly
AACC ID#
Proof of name change is required. You must submit an official court document, marriage certificate, or certificate of naturalization. Driver’s
licenses are considered acceptable for last name changes only. (MyAACC user name is not changed based on name change.)
I have read and understand the following:
To be considered for in-county tuition, I must reside in Anne Arundel County three months prior to the beginning of the term for
which I register. I may be required to submit a Residency Petition form if I have moved from out-of-county or out-of-state to Anne
Arundel County.
I must submit a Residency Petition Form if I wish to use a Post Office Box (PO Box) address.
I certify that the information provided on this form is accurate and complete.
Student Signature
________________________________________________________________ Date _________________________________
Notice of Nondiscrimination: AACC is an equal opportunity, affirmative action, Title IX, ADA Title 504 compliant institution. Call Disability Support
Services, 410-777-2306 or Maryland Relay 711, 72 hours in advance to request most accommodations. Requests for sign language interpreters, alternative
format books or assistive technology require 30 days’ notice. For information on AACC’s compliance and complaints concerning sexual assault, sexual
misconduct, discrimination or harassment, contact the federal compliance officer and Title IX coordinator at 410-777-1239, complianceofficer@aacc.edu or
Maryland Relay 711.
Rev. 06/2018
DEMOGRAPHIC INFORMATION CHANGE FORM
College Use:
_______________________ _____________________________
Processed by Date
Student Signature (Required)
FULL NAME ON FILE: (see below for name changes)
Last Name First Name M.I.
ADDRESS:
Street City State Zip Code
PHONE:
Home Cell
HOME EMAIL ADDRESS:
EMERGENCY CONTACT:
Contact Name Contact Phone Number
STARTING DATE AT ABOVE ADDRESS:
MM/DD/YY
PHONE:
Home Cell
Name Changes
NAME CHANGE:
Last Name First Name M.I.
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signature
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