Update January 2018
Registrar’s Office | NWACC
Change of Address and Other Information Form
If you are an NWACC employee, you must contact HR for all information changes
Student ID: __________________________ Phone: ______________________
Name: ______________________________ Date of Birth: _________________
I do hereby ask the Office of the Registrar to make the following correction(s) to my personal information. (All
documentation must be provided in a readable format)
Mailing Address Change (To change legal residency & tuition please use Tuition Change Form)
New Address Information:
Street City ST Zip
Phone Number Change New Phone Number:
Personal E-mail Address Change New e-mail:
Legal Name Change (Required Supporting Documentation - Official marriage certificate, birth certificate, or
other legal document outlining the change of name. To change preferred first name please use Preferred
Name Change Form)
Current Name New Name
Social Security Number Change (Required Supporting Documentation – Social Security Card)
SSN:
Date of Birth Change (Required Supporting Documentation – Driver’s License or Birth Certificate.)
DOB:
Gender Change (Required Supporting Documentation – Legal Document outlining change of gender.)
Gender: Male Female
Change of Emergency Contact
New Contact Name:
Last First MI
Contact Address:
Street
Zip
And
Contact Telephone Number: Relationship:
Student Signature: ____________________________________ Date: _______________
(Proof of identification must be provided at time of submission. If mailing include copy of valid photo ID.)
Mail Form and Documents to: Student Records Office, One College Drive, Bentonville, AR 72712
Turn in at: Enrollment Support Center, 2
nd
floor of the Student Center or Washington County Center.
Upload the document to: https://api.nwacc.edu/lss/finaid/filedropbox/ (You must have a My NWACC Connection login to
do this.)
B-S-ADMIN
Processed by: ________
Date: _______________
Scanned by: _________
Date: _______________
