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SY23-24 Student Account Change Form
Please provide documentation of new Proof of Residency, Proof of Guardianship, or Proof of Legal Name Change to
mwiesman@wivcs.org
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* Indicates required question
Your Name
*
Your answer
Student ID (if multiple students in family, list all)
*
Your answer
Full Name of Student(s)
*
Your answer
Legal Guardian Full Name
*
Your answer
Legal Guardian E-mail Address
*
Your answer
Legal Guardian Phone Number
*
Your answer
Is there a change in the street address?
*
Yes
No
New Address (include street number, street name, city, state, zip code)
Your answer
Date of Move
MM
/
DD
/
YYYY
Is the address listed above also the mailing & shipping address?
Yes
No
Clear selection
If No, what is the mailing & shipping address?
Your answer
Does the address need to be updated for the LC and/or legal guardian as well?
Yes
No
Clear selection
Is there a change in Learning Coach, addition of Learning Coach, or updated phone number or email address?
*
Yes, change to LC
Yes, add a LC
Yes, new phone number or email address
No
If yes, list Learning Coach change, new phone number or email address, or new Learning Coach information (Please include name, phone number, email, street address, and relationship to student)
Your answer
Does the Legal Guardian or Emergency Contact need to be updated?
*
Yes
No
If yes, please list new information for Legal Guardian and/or Emergency contact (Please include name, phone number, email, and relationship to student)
Your answer
Does the Student's Preferred Name need to be updated?
*
Yes
No
If yes, list the new Student Preferred Name
Your answer
If applicable, list the student's preferred pronoun(s)
Your answer
Any other information we should know?
Your answer
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