Fill out the following information and click 'Submit'.

ATTENTION: This form is NOT for new students.
    It is only for students who have been studying with SLBC for more than 60 days and who have
been away from their studies for at least 30 days with no contact of any kind with the college.

This form is for the student to verify: "Yes, I am still active."

   Attention: DO NOT use nicknames.
1. Use the exact name submitted on your Application form.
2. Use only your legal name on all forms submitted to SLBC.
    Your degree will be made out with your name exactly as it is submitted on your Application form.
3. Use only email addresses that are registered to you in your file here at SLBC.
4. Proper letter-case must be used in all communication sent to the college.
  This includes proper capitalization when you input your name.

If these guidelines are not followed then the form cannot be filed because we won't know who you are.

You must file this form each 30 day period that you are inactive.

*Student full name (Observe proper capitalization of the first letter of each of your names.):Enter ONLY your full name as it is found on your Application form. Enter your First Name and then Last Name.
*Date of your original Application form:
*Your Email Address:Use only an email address that is registered to you in your student file. Submit a Change of Email Address form to register any new email address.
*Verify Your Email Address:Use only an email address that is registered to you in your student file. Submit a Change of Email Address form to register any new email address.
*Is this a new email address:
Yes. No.
If this is a new email, what was your old email:If this is not a new email, then leave this field blank.

If no comment, leave the Comments box empty.
Be sure to observe proper capitalization while entering information in this box.

Comment:
*Is this an Original or Amended form:
Original Amended