Change of Personal Information

Change of Personal Information

Instructions: All requests require the student’s signature and one form of documentation (See Required Documentation). You may also submit this form along with the required documentation in person or via US mail, email or fax.
Name*

First NameMiddle NameLast Name
Maiden Name
Verify Identity

Please upload the following documents depending on your circumstance to verify your identity / information change.

Name Change: Marriage License/Certificate, Passport, Permanent Visa, Social Security Card, Birth Certificate, Court Order, Divorce Decree, Driver's License

Social Security Number: Social Security Card

Date of Birth: Birth Certificate, Passport, Permanent Visa
Required Documentation File Upload*

Acceptable file types include: pdf, doc, docx, xls, xlsx, csv, txt, rtf, jpg, jpeg, png, gif. Max file size, 10MB
Cancelof
What information are you requesting to change?
Name Change

First NameLast Name
Address Change

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Address Change Phone Number
Please enter a valid phone number.
Date of Birth Change - Old / Incorrect DOB:

MonthDayYear
Date
Date of Birth Change - New / Correct DOB:

MonthDayYear
Date
I certify that I am responsible for any changes made to my personal information record. I also understand that any changes may cause complications if transcript orders or other information requests are submitted to, or data provided by, the university under former personal information. My name serves as my electronic signature.
Electronic Signature*

Clear
Today's Date*

MonthDayYear
Date
Should be Empty: