Change/Correction of Student Information

Step 1 of 2: Submit

First Name: Last Name: Student ID# or DOB:

Change or Correction of Name

New Name: Former Name: Chosen Name: *If you'd like to be referred to by a name other than your legal name, please list below.

Please note: Documentation may be needed to complete this request. If so, a Records and Registration staff member will reach out to you.

Supporting Documentation

Change or Correction of Social Security Number

New Social Security Number: Former Social Security Number:

Please upload a copy of your Social Security Card or documentation from the Social Security Office and your photo ID.

Supporting Documentation

Change or Correction of Birth Date

New Birth Date:

Former Birth Date:

Please upload driver’s license or birth certificate for verification and your Photo ID.

Supporting Documentation

Change of Program

Programs indicated with an asterisk (*) are offered on-campus as well as fully online.

Academic Programs

Change or Correction of Address

New Address: (Please include street address, city, state and zip code.) Former Address:

I understand that if I have moved out of the Prairie State College district my tuition rate may be adjusted accordingly.

Proof of residency may be required for some students. If additional documentation is required, a member of the Records and Registration staff will contact you.

Supporting Documentation

Change or Correction of Phone Number

New Mobile: New Home:

Change or Correction of Email Address

New Email:

Electronic Signature:

Date: Monday, 13 October 2025 (EDT)

Name:

Type your name to sign this document:

Typing name is equivalent to a handwritten signature

Scan this QR code with your phone: