Personal Information Change Form

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Fields

Personal Information Change Request Form

Student Name*

First Name*

Last Name*

Student ID #*

Nine digit ID

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Date of Birth*

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Month

Day

Year

Email Address*

Phone*

Phone Type*

Home Mobile

Information to be updated*

Official Name Change Official Gender Change

Change Student Name to*

First Name*

Last Name*

Gender Change*

Male Female

(Reflects legal gender identity change)

Upload original or certified copy of legal documentation showing changes to your name and/or gender*

No File Chosen

File uploads may not work on some mobile devices.

Documentation Type*

Valid Driver’s License Marriage Certificate US Armed Forces ID Card Certified Court Order Social Security Number Card Valid Unexpired US Passport Certified Record of Divorce Naturalization Paperwork

Other: Other Value

Agreement*

By signing, I certify this declaration is made for purposes of my future academic record. I intend to use this name/gender consistently at Fox Valley Technical College from this date forward, for things such as official transcripts, financial aid, student identification, and student employment documents.

Signature*

[clear]

Use your mouse or finger to draw your signature above

Date/Time

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Month

Day

Year

Office Use Only

Check Required Documentation (copies not needed)

Change name in PeopleSoft (update primary and preferred if listed)

Update student Bio/Demo information as needed

Processed By*

First Name*

Last Name*

Date/Time*

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Month

Day

Year

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