OFFICE USE ONLY - Date Processed /Initials _______
Please return form to any Registration and Records Office. Fax: (630) 466-4964
Sugar Grove Campus STC 249 (Student Center) Aurora Downtown Campus DWNTN 112
Aurora Fox Valley Campus FOXVLY 231 Plano Campus PC 127
6/16/20
Effective Summer 2020
Waubonsee Community College does not discriminate based on any characteristic protected by law in its programs and activities
STUDENT INFORMATION CHANGE FORM
Complete only the boxes below that need updating. (Please type or print legibly)
: (Please type or print legibly)
Name: (First) _______________________________________(M) ________________________ (Last) ___________________________________________
(currently in Waubonsee system)
X-Number: __________________________
I h
ereby certify that, to the best of my knowledge, the information furnished below is true and complete. I request my Waubonsee Community College records be
updated accordingly. I understand that if requesting a name change during the semester, it is my responsibility to notify my instructor(s) after the change has been
processed.
: _______________________________________________
: ________________________
: (These changes must be done in person)
* Legal Name: (First) ____________________________ (M) ____________________ (Last) ________________________________
Preferred / Chosen Name: _____________________________________ Legal Sex: Male Female
* Date of Birth: _________________________ * SSN #: _______________________________
* Documentation such as a copy of your Social Security Card (signed), Valid Driver’s License or State ID, Marriage License, Valid
Passport, Birth Certificate, or Official Court Documentation must be submitted.
RESIDENCY & CONTACT INFORMATION
:
Mailing Address:
Address _________________________________________City_________________________State_________Zip_________
Permanent Home/Legal Residence Address (if different than above):
Address _________________________________________City_________________________State_________Zip_________
If your resident address status has changed you may need to provide 3 documents to verify (please see Documentation of Residency
on www.waubonsee.edu
).
Telephone: (Home) __________________________ Primary contact (Cell) _____________________ Primary Contact
Email: __________________________________________________
For the Semester:
Fall 20 _______ (Aug-Dec)
Spring 20 _____ (Jan-May)
Summer20 ____
(Jun- Jul)
ENROLLMENT INFORMATION:
Change Status:
Attend Full-Time (12 or more credit hours)
Attend Part-Time (less than 12 credit hours)
Financial Aid Applicant Yes No
Graduated High School (month/ year) ________________
