OFFICE USE ONLY: Processed by: _____________ Date: ___
SIMMONS UNIVERSITY
Office of the Registrar
300 The Fenway, Boston, MA 02115
Tel 617.521.2111 Fax 617.521.3144
registrar@simmons.edu
CHANGE OF NAME/ADDRESS
*Name change must be must be accompanied by legal documentation*
Current Name: ________________________________________________________________________
Simmons ID #: ______________________ Date of Birth: _____/______/______
E-mail Address: _______________________________ Daytime Phone: _________________________
Student Type:
Graduate Student Undergraduate, Class Year: ___________
Former Student: Please contact Alumnae Relations for Name and Address Changes
Student Signature: _______________________________________ Date: ____________________
Name change:
Former Student: Contact Alumnae Relations to change your name.
For current students: please complete this form and attach
legal documentation
, such as a driver’s
license, passport, marriage license, etc.
New Name: _____________________________________________________________________________
first middle last
Address change:
Former Student: Contact Alumnae Relations to change your address.
For current students: you can also update your address online at connection.simmons.edu.
After logging in to AARC, select ‘Manage Contact/Emergency Info.’
NEW:
Street, Apt. No.
City, State, Zip Code
Country (if outside U.S.A.)
click to sign
signature
click to edit
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