Of
fice of the Registrar • 156 College Rd • Soldotna, AK 99669• Phone 907-786-1480• Fax 907-262-0322•
registration@kpc.alaska.edu
Request for Change to Personal Information
Name
:
UA
ID
:
Preferred
Email:
______________________________________________________
(If KPC needs to contact you it will be through email.)
WHAT CHANGE WOULD YOU LIKE TO MAKE?
Address:
Address:
City:
County:
State:
Province:
Zip:
Mailing and Permanent addresses can be also be updated through UAOnline.
Name: (Include government issued identification with new name; employees require SSN Card)
Former
Name
Last:
First:
Middle:
Current
Name
Last:
First:
Middle:
Please note this change will not update/change university email account or current class rosters / blackboard.
Please contact IT Services at 907-262-
0351 for further assistance.
Date of Birth: ____________
___________________
MM/DD/YYYY
(Include government issued identification showing correct Date of Birth)
Social Security Number: ____________________________________________
(Must include signed SSN Card)
Gender: Male Female
(Include government issued ID)
I request the above change(s) be made in official University records in accordance with University policy and this form.
Signature:
Date:
VERIFICATION OF CHANGES (FOR OFFICE USE ONLY)
Verified and Entered by: ___________________________________ Date: ______________________________________
click to sign
signature
click to edit
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