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Student Record Update

The Student Record Update Form requires valid documentation for changes to name, birthdate, and gender, which must be submitted to the Admissions and Registration Office. Students can update their personal information, including address, telephone number, and email, while affirming the accuracy of the information provided. The form also includes a certification statement regarding the truthfulness of the information and its use for internal college purposes.

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Joselyn Herrera
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21 views1 page

Student Record Update

The Student Record Update Form requires valid documentation for changes to name, birthdate, and gender, which must be submitted to the Admissions and Registration Office. Students can update their personal information, including address, telephone number, and email, while affirming the accuracy of the information provided. The form also includes a certification statement regarding the truthfulness of the information and its use for internal college purposes.

Uploaded by

Joselyn Herrera
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Student Record Update Form

Form will not be processed for name, birthdate and gender unless valid documentation is attached and submitted to the Admissions and Registration Office.

Current Student Information (Please Print Legal Full Name): EPCC ID Number

Name: _______________________________________________________________ 8 ___ ___ ___ ___ ___ ___ ___


Last First Middle

Change of Name
Change name to (Please Print Full Name):

__________________________________________________________________________________________________________
Last First Middle
(Please provide a copy of one of the following types of documentation; a valid Naturalization Certificate w/picture and seal, a current U.S. Passport, a current Foreign
Passport, a valid State I.D. card, a valid State Driver’s License, a current Military I.D. Card, or a valid U.S. Government issued I.D., as well as a either a Marriage License,
Divorce Degree, legal court documents, or a Social Security card that reflect the same name as on the identification presented.)

Correction of Birthdate (MM/DD/YYYY) Change of Gender


Incorrect Birthdate:_______ / _______ / _____________ Male Female

Correct Birthdate:_______ / _______ / _____________ (Valid U.S. Government issued I.D. and legal court documents that reflect
(Valid U.S Government issued ID and Birth certificate must be attached) the same name as on the identification presented)

Change of Address
Mailing Street Address: ____________________________________________________________

City:______________________ State: ____________ Zip Code: ______________

Permanent Street Address: _____________________________________________________

City:______________________ State: ____________ Zip Code: ______________

Change of Telephone Number


Home: (_________) __________ -__________________ Cell: (_________) __________ -__________________

Emergency: (_________) __________ -__________________ Contact Name: __________________________________

Change of Personal Email Address


___________________________________________________@________________________________._____

Certification: I hereby affirm that the information given above is legally true and correct. I understand that giving false
information may make me ineligible for admission to El Paso Community College or subject to dismissal. I understand that the
information provided will be used internally for the purpose of updating my student records and for College business.

Student Signature_______________________________________________ Date:____________________

Received By: ____________________________________________ Date:____________________

*International Students: Please update address information with the International Student Office.
P.O. BOX 20500|EL PASO, TX 79998-0500|TEL:915-831-2150|FAX:915-831-2161|WWW.EPCC.EDU

4/15/2016

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