Fillable STUDENT INFORMATION CHANGE FORM (University of Massachusetts at Lowell)

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STUDENT INFORMATION CHANGE FORM (University of Massachusetts at Lowell)

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STUDENT INFORMATION CHANGE FORM
OFFICE OF THE REGISTRAR
220 PAWTUCKET STREET, UNIVERSITY CROSSING, SUITE M10
LOWELL, MA 01854
*Name change requires photo ID and official documentation (ie - marriage license, court papers).
phone: 978-934-2550
fax: 978-934-4076
email: registrar@uml.edu
First Name
SiS ID#
Date
Type of Change
*Name Telephone Billing Mailing Address Permanent Address Others
Last Name
Formerly Recorded Change to
First Name
Permanent Address
Others (specify)
Phone Number
Signature
Last Name
Billing Address
Phone Number
For Office Use Only:
MI
Rev. 12/10/2014
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STUDENT INFORMATION CHANGE FORM (University of Massachusetts at Lowell)

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Completed 24 July 2020

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