ORANGE COUNTY COMMUNITY COLLEGE 

 BURSAR�S OFFICE 

 

 CHANGE OF INFORMATION 

 

CURRENT INFORMATION NEW INFORMATION 

 

1. NAME_____________________________________________ REQUESTED NAME CHANGE: __________________________________ 

 

2. SOCIAL SECURITY #________________________________ CORRECT SOCIAL SECURITY#__________________________________ 

 

3. ADDRESS: NEW ADDRESS: 

 

______________________________________________________ ______________________________________________________________ 

 

 

______________________________________________________ ______________________________________________________________ 

 

______________________________________________________ ______________________________________________________________ 

 

MAILING ADDRESS: ( IF DIFFERENT FROM LEGAL ADDRESS ) 

 

________________________________________________________________________________________________________________________ 

 

________________________________________________________________________________________________________________________ 

 

 

EFFECTIVE DATE OF CHANGE: _________________________________________________________________________________________ 

 

4. TELEPHONE # : ______________________________________________________________________________________________________ 

 

 

 

SIGNATURE:__________________________________________ DATE: _______________________________________________________ 

_______________________________________________________________________________________________________________________ 

 CHANGE REQUIREMENTS

 

 1. NAME CHANGE REQUIRES A COPY OF MARRIAGE CERTIFICATE, DIVORCE DECREE, OR OTHER LEGAL DOCUMENT 
PERMITTING NAME CHANGE. * A DRIVER�S LICENSE CANNOT BE USED FOR A NAME CHANGE. 

 

 2. SOCIAL SECURITY NUMBER CHANGE REQUIRES SOCIAL SECURITY CARD. 

 

 3. LEGAL ADDRESS CHANGE WITHIN THE SAME COUNTY REQUIRES POSTMARKED DOCUMENT WITH NEW ADDRESS ON 
IT. ADDRESS CHANGE FROM OUT OF COUNTY TO ORANGE COUNTY REQUIRES DOCUMENT WITH DATE OF CHANGE 
SUCH AS UTILITY BILL, CABLE BILL, TELEPHONE BILL, ETC.. (A RENTAL AGREEMENT ALONE CANNOT BE USED FOR 
LEGAL CHANGE) ADDRESS CHANGE FROM OUT OF STATE TO IN STATE REQUIRES NEW YORK STATE INCOME TAXES 
(PARENT�S STATE AND FEDERAL INCOME TAXES IF DEPENDENT) NEW YORK STATE DRIVER�S LICENSE AND ONE OTHER 
DOCUMENT PROVING NEW YORK STATE FOR ONE FULL YEAR. 

 

 * ALL NAME AND/OR ADDRESS CHANGES REQUIRE A NEW CERTIFICATE OF RESIDENCE. 

________________________________________________________________________________________________________________________ 

 OFFICE USE ONLY 

 

NAME: ADDRESS: TELEPHONE: SS#: 

 

 

CODE FROM: TO BURSAR: DATE: 

 

SPRO/RGP: TO REGISTRAR: DATE: 

 

DELETE/REREG: SEMESTER