Change of Personal Information Form

OFFICE OF THE REGISTRAR

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.
Current Information
Name*
First Middle Last Maiden Name
REQUIRED DOCUMENTATION
NAME CHANGE Marriage License/Certificate or Passport or Permanent Visa or Social Security Card or Birth Certificate or Court Order or Divorce Decree or Driver’s License SOCIAL SECURITY NUMBER Social Security Card DATE OF BIRTH Birth Certificate or Passport or Permanent Visa
Required Documentation File Upload*
Drop files here or

Max. file size: 512 MB.
Submit according to the list above.
What information are you requesting to change?*
After selecting, complete the appropriate fields below.
Name Change
First Middle Last
Address Change
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone Number
Date of Birth Change
Old or Incorrect DOB
New or Correct DOB
New or Correct DOB
Electronic Signature*
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.
Date*
MM slash DD slash YYYY

Instructions