Fillable Student Data Change Admissions & Records OR - (Austin Community College)

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Student Data Change Admissions & Records OR - (Austin Community College)

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Admissions & Records
Student Data Change
Please use blue or black ink.
OR
Student ID Number
-
-
Social Security Number
Last Name
First Name
MI
Name Change--Requests must be submitted to any campus A&R office. Original documentation is required as proof of name
change. Acceptable documentation is listed on back of form. The student is responsible for changing name with BankMobile.
Name last enrolled under if different from above:
Social Security Number Change--Requests must be submitted to any campus A&R ofce. An original social
security card is required as proof of social security change.
c SSN or alternative ID number listed incorrectly
on ACC records
Incorrect #_________________________ Student #_____________________
c New/Changed SSN or alternative ID number
Correct #__________________________ Student #______________________
Date of Birth Change--Requests must be submitted to any campus A&R ofce. Original documentation is required as
proof of DOB change. Acceptable documentation is listed on back of form.
/
Date of Birth
/
Change of Address--This address will be used by ACC to mail all correspondence to students and to determine in-district
or out-of-district residency for tuition purposes. All P.O. Boxes are out-of-district. Proof of in-district address is required. Acceptable
documentation is listed on back of form.
Phone Number
Street Address
Home:
ork:
Cell:
City State
Zip Code
Received by:
Staff Member Initials
Signature of Student
Campus
Date
Date
A & R Office Use Only
Hold(s) Removed:
Coded:
Changed by:
(Staff Initials)
Date:
W
Non-Record
Audited by:
(Staff Initials)
Date:
ADRE 2.18
Reset
ALL FORMS OF DOCUMENTATION MUST BE VALID
Proof of Social Security Number
c Social Security Card
An A&R staff member will attach a copy of the original card to the completed form.
Proof of Date of Birth
One of the following:
Driver’s License or State ID
Passport
c
US Government Issued ID c
c
c Birth Certicate
An A&R staff member will attach a copy of the original documentation to the completed form.
Proof of Name
A government issued photo ID or driver's license and one of the following:
c
c
c
c
Certificate of Naturalization
Divorce Decree
Marriage Certicate
Court documentation of legal name change
An A&R staff member will attach a copy of the original documentation to the completed form.
Proof of Address
One of the following:
*The entire signed lease must be presented to A&R ofce.
Current Rental Lease* - Student must be leaseholder or listed as occupant
c
c
c
c
c
c
Property Deed
Current Utility Bill (Electric, Water, Gas, Landline telephone) - Student must be account holder or
listed on the account
Current Cable Bill or Home Internet Service Bill - Student must be account holder or listed on the
account
Property Tax Statement
Affidavit of Address**
**Student’s Texas driver’s license must reect address on Afdavit. Original Afdavit may not be faxed.
Change of Address requests may be mailed, faxed, or submitted to any campus A&R ofce. Please mail
completed form to ACC Admissions & Records, P.O. Box 15306, Austin, TX 78761-5306. You may also fax
a copy of this form to the ACC campus of your choice. A copy of a photo ID must accompany your mailed or
faxed request.
A&R Fax Numbers:
Cypress Creek
Eastview
512/223-2048
San Gabriel
512/223-2967
512/223-5900
Rio Grande
Riverside
512/223-3444
Highland
512/223-7125
512/223-6767
Northridge
South Austin
512/223-4651
512/223-9152
Non-Record
Round Rock
512/223-0920
Elgin
512/223-9588
Hays
512/223-1898
ADRE 2.18
Reset
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Student Data Change Admissions & Records OR - (Austin Community College)

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Completed 29 April 2021

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