ERROR:
JavaScript is not enabled. You must enable JavaScript in your browser to use this form
Please fill in a valid value for all required fields
Please ensure all values are in a proper format.
Are you sure you want to leave this form and resume later?
Are you sure you want to leave this form and resume later? If so, please enter a password below to securely save your form.
Save and Resume Later
Save and get link
You must upload one of the following file types for the selected field:
There was an error displaying the form. Please copy and paste the embed code again.
Apply Discount
You saved
with code
Submit Form
Submitting
Validating
There was an error initializing the payment processor on this form. Please contact the form owner to correct this issue.
Please check the field:
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
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands (US)
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces (the) Americas
Armed Forces Europe
Armed Forces Pacific
Army Post Office (U.S. Army and U.S. Air Force)
Fleet Post Office (U.S. Navy and U.S. Marine Corps)
State
ZIP Code
Date of Birth
*
https://foxvalleytechnicalcollege.formstack.com/forms/images/2/calendar.png
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
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
https://foxvalleytechnicalcollege.formstack.com/forms/images/2/calendar.png
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
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
*
https://foxvalleytechnicalcollege.formstack.com/forms/images/2/calendar.png
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2023
Previous
←
Next
→
Enter your save and resume password
Cancel
Confirm