Fillable ADDRESS /NAME CHANGE FORM (Nazareth College)

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ADDRESS /NAME CHANGE FORM (Nazareth College)

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ADDRESS /NAME CHANGE FORM
PLEASE SUBMIT COMPLETED FORM TO REGISTRAR’S OFFICE
PERMANENT ADDRESS CHANGE (RESIDENTIAL)
SCHOOL/LOCAL ADDRESS CHANGE (MAILING –
IF DIFFERENT)
By submitting this form with required documentation and signing below, you are requesting that the Nazareth
College Registrar’s Office change your name and/or your address. Additionally, you authorize the release of
name change documents, if requested, to the National Student Clearinghouse for the purpose of notifying
lenders and allowing employers and other authorized parties to verify your enrollment and/or degree.
_________________________________________________________ _____________________________
Signature Date
Office of the Registrar • Smyth 1
4245 East Ave • Rochester, NY 14618
Phone (585) 389-2816 • Fax (585) 389-2612
registrar@naz.edu
Contact Information
Name: _____________________________
Last 4 of SSN or Student ID#:___________
Phone Number: _______________________
Email address:
NEW ADDRESS
Street _________________________________________________________________________________________
City/State/Zip____________________________________________________________________________________
FORMER ADDRESS
Street _________________________________________________________________________________________
City/State/Zip__________________________________________________________________________________
NAME CHANGE -
Must provide legal documentation attached to form.
Ex: marriage license, valid driver’s license, etc.
NEW
NAME:___________________________________________
FORMER
NAME:___________________________________________
NEW ADDRESS
Street _________________________________________________________________________________________
City/State/Zip__________________________________________________________________________________
FORMER ADDRESS
Street _________________________________________________________________________________________
City/State/Zip__________________________________________________________________________________
For Office Use Only:
Processed by:______
Date: _____________
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ADDRESS NAME CHANGE FORM (Nazareth College)

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Completed 1 February 2021

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