ILLINOIS CENTRAL COLLEGE – CHANGE OF STUDENT INFORMATION
* If you need a change of name or social security number, submit this form with a copy of your driver’s license/state ID and social security
card reflecting the change(s) to Enrollment Services. A driver’s license/state ID and marriage license are also acceptable for name changes.
THIS IS A CHANGE OF: I AM AN ILLINOIS CENTRAL COLLEGE
Please check all that apply Check all that apply
Name * Student
Address Employee
Social Security Number *
Email
Name_______________________________________________ Student ID# (required)___________________________________
Previous Name(s):____________________________________________________________________________________________
Address____________________________________________________________________________________________________
City________________________________ County____________________________ State______________ Zip_______________
Phone__________________________________ Email__________________________________ Home Work
Signature (required)____________________________________________________ Date________________________
