Requester Information
Select one or more items to change.
Address
Home Address
Mailing Address
(Leave mailing address blank if same as home address)
Phone
Provide other phone number and type if not listed above
E-mail Address
Emergency Contact
Primary
Secondary (optional)
Smoking Status
Gender
Marital Status
Marriage Certificate required
Birth Date
Changes to Date of Birth require a copy of your birth certificate or government issued identification card
Highest Education Level
Changes require a copy of your transcript
Military Status
Changes require form DD 214 or ODEO certification for Vietnam Era Veteran status