Rev. 2/15/16
Office of the Registrar
Office of the Registrar
Change of Name and/or Address
Last First Middle
Last First Middle
New Name
Please attach copy of documentation, such as a marriage certificate, divorce
degree or other documentation pertaining to a name change.
After printing and signing this form, submit using one of the following methods:
--scan and email to registraroffice@webster.edu
--fax to 314-968-7112
--mail to: Registrar Office, LH 63, Webster University, 470 E. Lockwood Ave., St. Louis, MO 63119
ADDRESS CHANGE
Student ID Number: SSN Number:
Address
City State Zip Code
Country
Current Name
New Home Address
Phone Number
Address
City State Zip Code
Phone Number
NAME CHANGE
New Local Address
TO SUBMIT:
Student's Signature Date
Print Form
PRINT FORM
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