Change of Personal Information

Semester

Fall

Spring

Summer

Year

Student ID

Current Name

First Last

Previous Address (to be inactivated)

Street Address City State ZIP Code

Previous Phone Number (to be inactivated)

Previous Personal Email (to be inactivated)

Information to Change or Add

Legal Name Change (First, Middle, Last)

Preferred Name Change (First Name Only)

*A preferred name is the name a student wishes to be known by in the CCSNH System that is different from a legal name. It is not meant to be used to record a nickname (e.g. Jimmy for James). CCSNH preferred names applies to first names only. Any surname changes will need to be done through the legal name process.

Initial if changing name. Otherwise, leave blank. My initial here indicates that I am aware changing my first name, first initial, or last name will impact my access to SIS, WMCC email address, CANVAS, etc. I will contact WMCC IT Support at [email protected] to receive my updated username. I will inform my instructors of my name change.

New Personal Email Address (to be updated)

Signature

Date