Student Data Change Form

Student Name Change/Information Update Form

This form is used to communicate with the Pitt Community College Registrar and Records Office.

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Personal Information Currently on File at PCC

Enter the required personal information listed in your student record with PCC

Your Name(Required)

First Middle Last

PCC Email Address(Required)

PCC Student ID Number(Required)

New Name

First Middle Last

New Address

Street Address Address Line 2 City State ZIP Code

New Phone Number(s) – Cell Phone (Include Area Code)

Home Phone

Work Phone

For Name Changes Only:

The following documents must be submitted to the Registrar's Office to complete your request:
1- Copy of your picture ID,
2- Copy of your signed Social Security Card with your new name

In person:
Goess Student Center, Room 100 169 Bulldog Run, Winterville, NC 28590 Days: Monday - Friday Hours: 8:00AM to 5:00 PM
Email: registrar@my.pittcc.edu

*Need to ask a question concerning this form? Send an email with your questions to: registrar@my.pittcc.edu. or call 252-493-7690

Form Verification(Required)

I agree

By selecting this check-box, I agree that the information on this form is correct, and I will complete the submission by physically bringing the documentation to the Admissions and Record Office on the Pitt Community College Campus OR by scanning the documentation and emailing it to (need email address here).