Albert A. Sheen Campus 
RR1, Box 10,000 |Kingshill |Virgin Islands |00850-9781 
 
St. Thomas Campus 
#2 John Brewer’s Bay |St. Thomas | Virgin Islands |00802-9990 
 
CHANGE OF STUDENT PERSONAL INFORMATION 
 
Please complete the following information and provide required documentation for changes.  If you are providing legal or identity 
documentation, please deliver this form in person. Request submitted by e-mail, fax, or through third parties will not be accepted. Photo 
identification must have a clearly reproduced picture to be considered valid when provided.  Please allow 3-5 business days for 
processing.  Only complete the areas below that you are seeking to change.  
 
Section : Current Name and Contact Information on Record 
 
First Name: ____________________________________ Last Name: ____________________________ Student ID: ___
 
Email Address: _________________
 Home Phone: _____________ 
Cell Phone: _
 
Mailing Address: ___________________________________________________________________________________________________ 
Section B: Current Name and Contact Information on Record (Check the applicable box) 
 
The University requires a valid Photo ID plus at least one of the following documents (as indicated beside each reason) to support your 
identity and name. Original or certified true copies of documents must be provided 
 □ Correction or addition to your name (Passport, Social Security Card) 
□ Correction of Birth (Birth Certificate, Passport) 
□ Name change by marriage (Marriage Certificate) 
□ Name change by Divorce (Issued Court Order) 
□ Return to maiden name (Issued Court order and Birth Certificate) 
□ Legal Name change (Change of Name Certificate Affidavit issued by the Court)  
□ Change of Address (No documentation needed)  
 
Section C: Requested Amendment(s) to Name and/or Other Information (Name and Date of Birth must match 
documentation submitted) 
 
Use upper and lower case letters, and include hyphens, periods, and spacing as required (e.g., “Manuela Ann-Marie D’Souza). Please 
note: accents cannot be accommodated.  
 
__________________________________________________________________________________________________________________ 
Last Name 
 
__________________________________
 ________________________________________________ 
First Name(s)                                                                                                                 Prefix 
 
__________________________________________________________________________________________________________________ 
Middle Name (s) / Initial (s)  
 
Section D: Change of Permanent Address/ Mailing Address  
 
 
__________________________________________________________________________________________________________________ 
New Permanent  Address  
 
__________________________________
 
New Mailing Address  
 
 
I confirm that I am the student as stated. The Information provided is true and accurate in all respects.  
_______________________________________________________________________________________               ___________________ 
Print Name                                                                                           Student’s Signature                                                   Date (dd/mm/yy)              
 
Rev 6/13/2016  
Office Use: Documentation Provided  (Check All That Apply) 
 
□ Court Order       □ Divorce Documents           □ Birth Certificate     □ Marriage Certificate     □ Naturalization Documentation  
□ Passport           □ SSN/Card                            □ Driver’s License   □ Voter’s ID                      □ Other Legal Documentation _______________________________ 
 
 
 
Documentation Reviewed and Processed by: ________________________________________  Date : ________________