Change of Name or Address

First name

Last name

Middle name

Student ID number

Birthdate

Previous name (if applicable)

If you are not requesting to change your name, enter N/A

New mailing address (if applicable)

City

State

ZIP code

Cell phone

Home phone

Email address

Documentation is required. Please include with this form (e.g., a piece of mail, marriage license, etc.).

Select file(s)

You may upload multiple files but you must select them all at once.
Allowed file formats: .doc, .docx, .pdf, .xls, .xlsx, .jpg, .jpeg, .png

If you are human leave this field blank

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