Student Information Update Form

First Name*

Middle Name*

Last Name*

*If your last name has changed since you applied to RBC, documentation is required as proof. Documentation includes a driver's license, marriage certificate, Social Security card, etc. The necessary notarized document(s) along with a printed copy of this form may be mailed to the Office of Financial Aid, Richard Bland College, S. Prince George, VA 23805.,

R Number*

Do you have the resources necessary to complete courses remotely (i.e., not on campus)?*

Yes No

Other:

Home Phone Number (include area code)*

Cell Phone Number (include area code)*

Personal Email Address*

RBC Email Address*

Parent/Guardian Email Address*

Address*

Address Line 1

Address Line 2

City, State*

Zip Code*

Country

Emergency Contact Name*

First Name

Last Name

Your relationship to your emergency contact (parent, grandparent, sibling, etc.)*

Emergency Contact Address*

Address Line 1

Address Line 2

Emergency Contact City, State*

Emergency Contact Zip Code*

Emergency Contact Country

Country

Emergency Contact Phone Number (include area code)*

*If your last name has changed since you applied to RBC, documentation is required as proof. Documentation includes a driver's license, marriage certificate, Social Security card, etc. The necessary notarized document(s) along with a printed copy of this form may be mailed to the Office of Financial Aid, Richard Bland College, 11301 Johnson Road, S. Prince George, VA 23805.

*If your last name has changed since you applied to RBC, documentation is required as proof. Documentation includes a driver's license, marriage certificate, Social Security card, etc. The necessary notarized document(s) along with a printed copy of this form may be mailed to the Office of Financial Aid, Richard Bland College, 11301 Johnson Road, S. Prince George, VA 23805.

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By providing my signature below, I certify that the above information is true and correct and I authorize Richard Bland College to update my record as stated.*

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