Change Name / Preferred Name or Address Form

Update personal information such as preferred name, legal name, address or phone.
A short description to explain the nature of a ticket.
Please enter your Student or Banner ID.
Please enter the date your address change or name change was effective.
Change Type
What type of change are you requesting (check all that apply):
Change Type
Please enter previous address here (Street, City, State, Zip)
Enter new address here (Street, City, State, Zip)
Enter previous phone number here.
Enter new phone number here.
Cell Number
Is this a new cell number?
Cell Number
Phone Type
Please Check One:
Phone Type
Preferred Name Change: A preferred name as it refers to our student information system is the name that prints on mailings, class rosters, and is displayed in Self-Service and D2L. All official documents, including transcripts and diplomas, will reflect your full legal name that is in our student information system.
Enter your full previous legal name
Enter your new full legal name
Please select which documentation you are submitting for legal name change:
*Please attach one of the following documents to this form for a name change.
Please select which documentation you are submitting for legal name change:
Please attached Name-Preferred Name-Address Change Form and copy of documentation for legal name change. To select multiple documents, press Ctrl and select.
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Other Fields

Your name
Verification Code