Massachusetts Community College Council

Address / Phone / Name Change Form

Alternatives to using this form include:
Call the office toll free at 1-877-442-MCCC
Mail your changes to MCCC, 27 Mechanic St. - Suite 104, Worcester, MA 01608-2402

Notice: A copy of this information is emailed to the MCCC Office, the MCCC Treasurer, and the Sender.

Please use this form to send a personal information change to the MCCC office. Your Name and SSN authenticate the change.

Please enter all information and we will update our records accordingly.


Name


(name we should have on file for you)

SSN

-- Please enter the 4th and 5th digits of your social security number to authenticate your change.


New Name if you are entering a name change


New Full Home Address

Address 1

Address 2

City, State, Zip


Home Tel #

--


College


MCCC Unit membership:
(check one only)

Full Time   DCE   Part Time Day


Email address: Note: If the Email address is not filled in correctly we cannot email a copy of your electronic submission back to you.


Other information that may help keep our records up-to-date.


Upon submission you should receive (1) a report on your browser window and (2) an automatic email reply - if you supplied an email address. This confirms that an email with your information was sent to the MCCC office.


Return to the MCCC Home Page WITHOUT submitting this information