Last Namerequired

First Namerequired

Middle Inital

Vanguard Student ID Number

I do not remember my Student ID Number

Checkbox

Last 4 of your SSNrequired

Birth Daterequired (mm/dd/yyyy)

What is your email address?required

Terms of Acceptance and Signature

I, for this Change of Email Address Form, warrant the truthfulness of the information provided in this application.

I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.*

I accept