Student
ID #:
Guilford Technical Community College
P. O. Box 309, Jamestown, NC 27282
Directions: Submit to Enrollment Services an Official State or Federal Photo ID with updated name.
Documentation is required
Name changes can be done at any time by completing a Student Name & ID Change Form with
Enrollment Services. You MUST provide an alternate email address to be informed when your User ID
has been changed. Changes cannot be made without Student ID entered in the boxes above.
Reason For Name Change: ( ) Citizenship by Naturalization ) Correction
( ) Marriage ( ) Divorce Court-Action
Do you wish to have your GTCC User ID/Email address changed? Yes No
Former or Incorrect Name: (please print)
(First) (Middle) (Last)
Alternate email address is required in order to notify you
when changes have been completed:
_________________________________________________
Contact Phone #:__________________________________
Date of Birth:______________
New Legal or Corrected Name: (please print)
(First) (Middle) (Last)
Authorization - Please read and sign: The information on this form and the attached documentation
represent accurate and legally acceptable proof of my name. Please change all records to reflect this
name and User ID.
Student’s Signature:
Date:
For Office Use Only:
This form must be submitted to the Enrollment Services Office with appropriate documentation
and signed by the person that accepts the form. Staff Person that received information:
Name:
Office:
09/18
