Student Reactivation Form

Student Information

First Name: *This question is required.

Last Name: *This question is required.

Student ID M-

Birth Date (MM/DD/YYYY)

SSN (last four digits) ***-**-

Previous First Name:

Previous Last Name:

Curriculum Title:

Curriculum Code:

Note: Changes to name, Social Security Number [SSN] and/or gender, require legal proof of the action in order to update. Proof includes driver’s license, social security card, legal court documents, and/or intent of gender change (doctor's letter). This documentation must be submitted to the Office of Admissions and Records at your primary campus of attendance.

Note: The curriculum title is the name of your program of study/major, and the curriculum code is the three digit number (which might also include a letter) that indicates your major/program of study. A list of programs can be found in the Course Catalog.

Address/Declaration of Permanent Domicile for Tuition Purposes

Note: Students with temporary visas, including B(tourist), F(student) and J(exchange visitor) are not eligible for in-county or in-state tuition based on residency. Other non-U.S. Citizens must show proof of immigration status (e.g. employment authorization or passport), or be charged the out-of-state tuition and fees rate. For information about in-county or in-state tuition, call (240) 567-5000 or visit the Office of Admissions and Records at your primary campus of attendance.

Contact Information

Address: *This question is required.

City: *This question is required.

State: *This question is required.

Zip Code: *This question is required.

How long have you lived at your current address?

Years
Months

Home Phone:

Work Phone:

Cell Phone:

Email: This question requires a valid email address.

Citizenship:

If Other than U.S., Current Immigration Status (I-94)

Do you (or your parents) own or rent your primary residence?

If yes, located in

County
State

Do you file income taxes?

If yes, filed to

County
State

Are you registered to vote?

If yes, registered in

County
State

Do you have a valid driver’s license?

If Yes,

State

Do you own a motor vehicle?

If Yes, registered in

State

Student Confirmation

By clicking the Submit button, I certify that the information on this form is correct and complete. I understand that falsification may result in dismissal and/or retroactive adjustment of tuition and fees. Upon request by a designated College official, I agree to provide additional evidence of the above facts for verification by the College.