Change in Name or Address

Please complete & submit this form if you need to change your name, address, or name.

Student ID or Last 4 SS#*
Name*
First Middle Last
Email*
New Address (if applicable)
Street Address Address Line 2 City State ZIP Code
New Phone Number (if applicable)
Emergency Contact Name and Relationship
Emergency Phone Number
New Name (if applicable)
Acceptable Documentation Provided
Please upload one of the following documents in the drop box below.
- Government Issued Identification
- Marriage Certificate
- Divorce Decree
File
Change in Marital Status (used for reporting purposes only)
- Married
- Divorced
- Widowed
Consent*
I hereby certify that by selecting the “I Accept” button, I am signing this request form electronically and that my electronic signature is the same as my handwritten signature.