Student Change Of Information Form

Important: Name changes require documentation meeting I9 guidelines which may be provided in person on campus or an image emailed to DianeM@IndianaMassageCollege.com.

Which Items Would You Like To Change? (Check All That Apply)*
- Select All
- Name
- Address
- Phone Number
- Email Address
Current Information On File
Student Name*
Date Of Birth*
Date Format: MM slash DD slash YYYY
New Information
Name
First Last
Address
Street Address Address Line 2 City State ZIP Code
Phone
Email

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