Student Data Change Form

Name(Required)

First Middle Last

Social Security Number - Last 4 digits(Required)

Student ID

Phone

Email(Required)

What type of change do you want to make?

Select all that apply

Name Change

Address Change

Change in Residency Petition

Name As Corrected:(Required)

First Middle Last

Current Address:(Required)

Street Address City State ZIP Code

From Date:(Required)

Previous Address:(Required)

Street Address City State ZIP Code

From Date:(Required)

Indicate Type of Petition(Required)

Change from out-of-state to in-state status

Change from out-of-state to in-district status

State Reason For Petition:(Required)

Attach any documentation for petition

Max. file size: 1 GB.