Profile Merge Request Form

Active Student ID *

Name *

First

Last

Identity Verification Birthdate *

Gender *

Female
Male
Non-Binary

List your other CSI Student ID (s) to be merged: *

Please separate each ID by comma.

Please provide as much additional information to assist us in identifying your profiles (i.e., email addresses, phone numbers, maiden, alias, common names, course enrollment or completion, etc.) *

Please provide current information associated to your "Active Student ID"

Business Email Address *

Personal Email Address *

Business Phone *

Personal Phone *

Employer *

Business Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Employee Number

Home Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country