DATA CHANGE FORM
Student Name: _________________________________ NSU ID: N ______________________________
Please make the following changes to my records:
Name* Address Phone Email Social Security Number*
Individual Taxpayer Identification Number (ITIN)* Date of Birth* Other
Name change:____________________________________________
Last
____________________________________________
First
_____________________________________________
Middle
--------------------------------------------------------------------------------
All other changes:
*Requires copies of official documentation
Name Change
Submit a copy of one of the following along with your completed form: divorce decree, driver’s license, certificate of
naturalization, permanent resident card, passport, court order, or uniformed service military ID.
Social Security Number Change
Submit a copy of your signed social security card along with your completed form.
Individual Taxpayer Identification Number (ITIN) Change
Submit a copy of your ITIN Assignment Letter along with your completed form.
Date of Birth Change
Submit a copy of one of the following along with your completed form: birth certificate, driver’s license, certificate of
naturalization, permanent resident card, passport, or uniformed service military ID.
Submit your request with any required documentation in person to one of the One-Stop Shops located in the Horvitz and Terry
Administration Buildings, by email to studentupdates@nova.edu, by fax to (954) 262-2915, or by mail to:
Nova Southeastern University
Attn.: Data Entry
3600 South University Drive
Fort Lauderdale, FL 33314
NSU employees must use the Office of Human Resources form www.nova.edu/hr/forms/change_of_name.pdf to process a
name change.
Student Signature: ______________________________ Date: ______________________
