Paul D. Camp Community College – Change of Student Information

Fill out your name and Student ID (Emplid). In the Student New Information section, check any item you wish to change and fill in the new information. Sign at the bottom of the page and return to the Admissions Office.

* Indicates a required field.

Student Information

First Name

Last Name

Student ID (Emplid)

Student New Information

Change my name to: Name change will require driver's license, military ID, permanent resident card, or passport.

Change my Social Security Number to: (Must present the original Social Security card)

Change my address to:

Change my phone number to:

Home: ( ) –

Work: ( ) –

Change my Veterans Educational Benefits eligibility to NO.

I received a High School Diploma or GED from:

Date received:

Change my advisor to:

Change my domicile to in-state (appropriate documents must be attached).

Other change:

Signature

Date

For the Office of Admissions Use Only

Processed by

Date