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Updated 10/2/2019 WVC Student Information Update Form WENATCHEE VALLEY COLLEGE WENATCHEE VALLEY COLLEGE (OMAK) 1300 Fifth Street, Wenatchee WA 98801 116 West Apple Ave, Omak WA 98841 Phone: (509) 682-6806 Fax: (509) 682-6801 Phone: (509) 422-7800 Fax: (509) 422-7801 Email: [email protected] Email: [email protected] When do you plan to return? Year__________ Summer (June - Aug.) Fall (Sept.- Dec.) Winter (Jan.- March) Spring (April - June) Name ______________________________________________________________ Social Security Number Other Name(s) Used _________________________________________________ Date of Birth_______________ Mailing Address ___________________________________________ City _________________________ State _______ ZIP__________ Phone number __________________ E-mail Address (student/personal)____________________________ To comply with federal laws, we are required to ask for your Social =Security Number (SSN) or Individual Taxpayer Idenficaon Number (ITIN). We will use your SSN/ITIN to report Hope Scholarship/Lifeme Learning tax credit; to administer state/federal financial aid; to verify enrollment, degree and academic transcript records; and to conduct instuonal research. If you do not submit your SSN/ITIN, you will not be denied access to the college; however, you may be subject to civil penales (refer to Internal Revenue Service Treasury Regulaon 1.6050S-1(e)(4) for more informaon). Pursuant to state law (RCW 28B.10.042) and federal law (Family Educaonal Rights and Privacy Act), the college will protect your SSN from unauthorized use and/or disclosure. PROGRAM OF STUDY _____________________________________________ PROGRAM OF STUDY (PROGRAMS LISTED ON OTHER SIDE) RESIDENCY STATUS 1.Have you lived in the State of Washington for the past 12 consecutive months? 2. Do you have a driver’s license or state ID? If yes, in what state is your current driver’s license issued in? State: _________ 4.Are you active duty military or the spouse or dependent of an active duty military member? 5.Are you a Washington National Guard member or the spouse of dependent of a Washington National Guard member? Yes | No Wenatchee Valley College is commied to a policy of equal opportunity in employment and student enrollment. All programs are free from discriminaon and harassment against any person because of race, creed, color, naonal or ethnic origin, sex, sexual orientaon, gender identy or expression, the presence of any sensory, mental, or physical disability, or the use of a service animal by a person with a disability, age, parental status or families with children, marital status, religion, genec informaon, honorably discharged veteran or military status or any other prohibited basis per RCW 49.60.030, 040 and other federal and state laws and regulaons, or parcipaon in the complaint process. The following persons have been designated to handle inquiries regarding the non-discriminaon policies and Title IX compliance for both the Wenatchee and Omak campuses: To report discriminaon or harassment: Title IX Coordinator, Wenatchi Hall 2322M, (509) 682-6445, [email protected]. To request disability accommodaons: Director of Student Access, Wenatchi Hall 2133, (509) 682-6854, TTY/TTD: dial 711, [email protected].
