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STUDENT'INFORMAT ION'CHANG ES' (Elgin Community College)

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STUDENT'INFORMAT ION'CHANG ES'
!
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STUDENT’S''NAME:'________________________________________________________________! !
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ECC'ID#'__________________________! ! BIRTHDATE______________________!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
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NEW'ADDRESS:'! !
STREET_________________________________________________________!APT#!________!
! CITY!________________________________________!STATE!_________!!ZIP____________!
PHONE!#!_____________________! CELL!#_____________________! BUS#!________________________!
E4MAIL!ADDRESS!_____________________________________________________________!
NAME'CHANGE:'
'
CHANGE!NAME!FROM________________________________________________________!
CHANGE!NAME!TO!___________________________________________________________!!
(Requires!legal!documentation!brought!to!the!registration!office.!
Marital!changes!require!a!copy!of!marriage!certificate)!
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SOCIAL'SECURITY'NUMBER:!!!!!!!!!!!!!!!!!!!!!
PROVIDING!FIRST!TIME!_____________________________________________________!
INCORRE CT !NUM BER_________________________________________________________!
! CORRECT!NUMBER!___________________________________________________________(!Attach!copy!of!Social!Security!Card!)!
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STUDENTS'SIGNATURE____________________________________________________________! DATE_______________________!
! !
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PROCESSED!BY!__________________!DATE!_____________!SCANNED!_______________!!!!
INDI!TO!INDI_____!!IN DI!T O!O U DI_____!!O UD I!TO !IN DI **_____!WID_____!!JTA______!!
**Residency!Requirement:!!Lic!___!WID___!!Lease___!!Utility!Bills___!!!
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STUDENT'INFORMAT ION'CHANG ES' (Elgin Community College)

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Completed 15 September 2020

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