Big Spring SD Information Change Request Form

Student(s)*

	First Name	Last Name	Grade	School Building	Student Have IEP
Student 1
Student 2
Student 3
Student 4
Student 5
Student 6

	Parent/Guardian Name Change

2.	Previous Name

3.	New Name

	Phone Number/Email Address Change

Do you wish to initiate any other changes of information?
If a field is left blank, information will not be changed. If you wish to remove current information, please enter BLANK in the field.

	First Name	Last Name	Email Address	Main Number	Alternate Number	Global Connect Number
Parent/Guardian 1
Parent/Guardian 2

	Emergency Contact Changes

Name of Emergency Contact(s) to be removed

	First name	Last Name
Contact Name
Contact Name
Contact Name

	Biological parents cannot be deleted without legal documentation of restricted or terminated parental rights.

Emergency Contact(s) to be added

	First Name	Last Name	Phone Number	Relationship
Contact Information
Contact Information
Contact Information

7.	Parent Name/Signature*

8.	Contact Phone Number if the registrar has questions

9.	Contact Email Address

Student Information Change Request Form