STUDENT NAME CHANGE FORM
Requires a valid picture ID (Driver’s license, valid passport, military ID, or other form
of government-issued (national or foreign) identification that show name, address, date
of birth, signature, and photograph are all acceptable forms of identification, unless
there is any reason to question their authenticity.) and one of the following:
Marriage decree
Divorce decree
Court order
Certificate of U.S. Citizenship
Other legal documentation
If seeking financial aid, proof of authenticity must include a Social Security Card with
the new name reflected on it. If receiving a student loan, the student must also contact
the lender and/or guarantee agency to change his/her name.
Internal use only:
____Update name in ISRS
_____ Initials
____ Scan all documents except Social Security Card
_____ Initials
____If Social Security Card is included, route form and all other documentation to Financial Aid for scanning
_____ Initials
____ Route form to Registrars Office (525B in TRF) for Image Now updates
_____ Initials
4/18/2019 nkc
Star ID/Student ID:
Student Name:
Name Used Formerly
Effective Start Date: Year: _________ Fall Semester Spring Semester Summer Semester
Your NCTC email address is most likely: FirstName.LastName@go.northlandcollege.edu
Please allow at least two days for the name change in your e-mail address to appear. Please check your e-mail
often as it is the official means of communication for important deadlines & information.
Signature:
Date:
Advisor Initials:
Northland Community and Technical College is an affirmative action, equal opportunity employer and educator.
This document is available in alternative formats to individuals with disabilities, consumers with hearing or speech disabilities may
contact us via their preferred Telecommunications Relay Service by dialing 711 (toll-free nationwide).
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome