4601 COLLEGE BOULEVARD
FARMINGTON, NM 87402-4699
PHONE: (505) 566-3545
FAX: (505) 566-3500
STUDENT CHANGE OF
NAME/ADDRESS/PHONE
Current Name: _________________________________
SJC Student ID# _______________________
(As it appears in our system)
NOTE: THIS FORM DOES NOT UPDATE YOUR RESIDENCY.
PLEASE CHECK WITH ADMISSIONS & RECORDS FOR APPROPRIATE FORMS TO UPDATE YOUR
RESIDENCY INFORMATION.
NEW INFORMATION / Please enter only the information you want to change
New Name
(The student must submit legal documents in support of name change: driver’s license, social security card, marriage license,
or divorce decree.)
________________________________________________________________________
Legal Last
Legal First
Legal Middle
New Address/Phone
________________________________________________________________________
____________________________________________________(____)______________
City
State
Zip Code
Telephone
STUDENT SIGNATURE _________________________________ DATE ________________
Updated 12/8/2010