Declare of Major/Change in Curriculum
First Name MI Last Name
Are you applying for ﬁnancial aid or veterans beneﬁts? Date of Birth Banner ID Number
Please complete this form, sign, date and mail to: Manchester Community College, Registrar’s Ofﬁce, Great Path, MS #13, P.O. Box 1046, Manchester, CT 06045-1046
or fax this form to 860-512-3221.
City State Zip
Home Phone Number Cell Phone Number Work Phone Number
Student Signature Date
New Curriculum/Major Please select only one designation.
FOR REGISTRAR OFFICE USE ONLY
Date Student Record Updated _____/_____/________
High School Transcripts/Diploma ¨ Yes ¨ No Immunizations ¨ Yes ¨ No
In order to process your request, we must have on ﬁle:
1. Your high school transcript or a copy of your original high school diploma.
2. Documentation of two each of measles, mumps, Rubella and varicella (chickenpox) vaccines administered at least one month apart.