Student Information Change
Form
Processing time is one business day
Completion of a name change request will change all records maintained by the Office of Student Records.
This will not change your username or email address for Smartweb.
*You may return the completed form and required document(s) to the Office of Student Records or email
to student.records@augustatech.edu
Personal Information:
SSN/Student ID: Birth date:
Name as it appears on records today:
New Name: First Middle Last
ADDRESS CHANGE:
Current Address:
Street:
City, State, Zip:
County:
Current Telephone Numbers: Current Email Address:
Home: Personal:
Cell:
Work:
DOCUMENTATION:
The required document(s) listed below must be submitted with a name change request. Choose one
document from column A or two documents from column B.
Adoption Papers
Court-Issued Name Change
Divorce Decree
Marriage Certificate
Birth Certificate
Certificate of Naturalization
Citizenship Papers
Driver’s License or ID card
Military ID
Passport
Permanent Resident Card
Social Security Card
By providing my contact information, I give Augusta Technical College permission to contact me at the
telephone numbers I have provided via any means, including text message and voice.
Student Signature: Date:
click to sign
signature
click to edit
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