Student Record Update

Indicates required field

Student Information

First Name

Last Name

Previous Name

Date of Birth

Phone Number

Email Address

Street Address

City

State

Zip Code

New Major

Previous Degree(s)

Associates

Bachelors

Graduate or Professional

Previous College(s) Attended

Name of Institution	City	State
Name of Institution	City	State

Proof of Identification

Government-issued ID is required. Please submit both front and back

Make sure your photo ID image is clear and readable or you may be asked to submit a new form.

Maximum 2 files.
10 MB limit.
Allowed types: jpg, png, jpeg.

Signature

Student ID/Password

I would like my Student/TechID number and password emailed to me. (Your password will be reset.)

Student Signature

Sign above