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Home » Change of Personal Data Form

Change of Personal Data Form

Please complete the following information, a confirmation email will be sent to your student email for verification.

If you have questions, call (856) 227-7200 ext. 4200 or email us at registrationservices2@camdencc.edu from your student email account.

Student Information
Student ID#*
Student Name*
Phone*
Phone Type
- Home
- Business
- Cell
Email*
You must use your student email.
I want to change my*
- Address
- Name
- Social Security Number
Change of Address
In order for this change to be processed, you must upload a document supporting the address change.
Previous Address*
Street Address City State / Province / Region ZIP / Postal Code Country
New Address*
Street Address City State / Province / Region ZIP / Postal Code Country
County of Legal Residence*
- Camden
- NJ County other than Camden
- Out of State
- Out of Country
Please upload proof of new address (JPG, PDF or GIF)*
Accepted file types: jpg, pdf, gif, Max. file size: 64 MB.
Change of Name
Previous Name*
New Name*
Login credentials for the student portal and student email includes your partial name. Do you wish to update your credentials?*
- Yes
- No
If yes, your username and CCC email will change. You will receive a notification via your personal email account. Please be sure to complete the email address above. Once updated, former credentials will be disabled. Your password will not change.
Acceptable proof for change of name must be one of the following (check one)*
- Marriage License
- Divorce Decree
- Adoption Papers
- Driver’s License
- Court Name Change Authorization
- Social Security Card
Upload a copy of Acceptable Proof (PDF or JPG)*
Accepted file types: pdf, jpg, Max. file size: 64 MB.
Change of Social Security Number
In order for this change to be processed, you must upload a copy of your Social Security Card,
Old/Wrong Social Security #*
New/Correct Social Security #*
Please upload a copy of your Social Security Card (PDF, JPG, GIF)*
Accepted file types: jpg, pdf, gif, Max. file size: 64 MB.
Signature*
Date*
MM slash DD slash YYYY

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Camden County College does not discriminate in admissions or access to, or treatment or employment on the basis of race, creed, color, national origin, ancestry, nationality, age, sex, sexual orientation, marital status or domestic partnership or civil union status, gender identity or expression, or persons with a mental or physical disability, or any other legally protected characteristic, in its programs and activities. The following persons have been designated to handle inquiries/complaints regarding non-discrimination policies:

Title IX Coordinator: Executive Dean, Student Affairs, 856-227-7200, ext. 4371, Taft Hall, Room 233, Blackwood Campus
Deputy Title IX and ADA Coordinator for Employees: Assistant Director of Human Resources, 856-227-7200, ext. 4391, Roosevelt Hall, Room 106, Blackwood Campus
Deputy Title IX and Section 504 Coordinator for Students: Associate Dean of Students, 856-227-7200, ext. 5088, Taft Hall, Room 302, Blackwood Campus
Title II for Employees and Students: Building Operations Manager, 856-227-7200, ext. 4575 Physical Plant, Blackwood Campus
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Students and employees have the legal right to appeal grievances with the local Office for Civil Rights, New York Office for Civil Rights, U. S. Department of Education, 32 Old Slip, 26th Floor, New York, New York 1005-2500, Telephone 646-428-3900, Fax: 646-428-3843; Tdd: 800-877-8339,EmaOCR.Newyork@Ed.Gov

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