Fillable Student Change of Name Form/ Preferred Name Form (Coconino Community College)

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Student Change of Name Form/ Preferred Name Form (Coconino Community College)

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The Student Change of Name Form/ Preferred Name Form (Coconino Community College) form is 1 page long and contains:

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  • 4 check-boxes
  • 21 other fields

Country of origin: US
File type: PDF

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Student Change of Name Form/
Preferred Name Form
Registration and Enrollment Services
Phone: 928-226-4299
Fax: 928-226-4033
Email: enrollment.services@coconino.edu
@ ID or Comet ID:
Birthdate: (MM/DD/YYYY)
NAME CURRENTLY ON RECORDS
Last Name:
First Name:
Middle Name:
Suffix:
Address:
City:
State:
Personal Email:
CCC Student Email Address:
PREFERRED FIRST NAME REQUESTED
First Name:
I understand that a preferred first name will not appear in all locations on my student record and that most records require that legal name be displayed.
Signature (Required):
Date:
Instructions for Legal Name Changes Only
To help protect students from identity theft or inappropriate access, each name change request requires, at a minimum, two different
forms of documentation, one of which must be picture identification. Additional documentation may be requested for some name changes,
such as when completely new first and/or last names are requested.
Instructions
1. All requests require:
a.
Student’s signature
b.
Copy of government issued photo identification.
c.
A copy of one of the following documents verifying the name change:
Marriage License
Adoption Papers
Court Order
Certificate Divorce Decree
2. All requests from foreign passport and permanent resident card holders also require a copy of the requestor’s foreign passport or
permanent resident card.
If submitte
d electronically, requests must be submitted via the Registration Secure Upload (https://www.coconino.edu/upload) . Printed and signed
forms and documentation can be submitted in person or physically mailed at/to any of our campuses.
You will be notified by email once we have
completed the name change or if we are unable to complete the name change.
Registration and Enrollment
Services
Lone Tree Campus
2800 S. Lone Tree Road
Flagstaff, AZ 86005
928-527-1222
Fourth Street Campus
3000 N. Fourth St.
Flagstaff, AZ 86004
928-526-7600
Page Instructional Site
475 S. Lake Powell Blvd.
Page, AZ 86040
928-645-3987
Office Use Only
Entered
by:
Date:
LEGAL NAME CHANGE REQUESTED
Last Name:
First Name:
Middle Name:
Suffix:
I certify that all the information supplied by me on this application is correct and complete. I also understand that any misrepresentation or
falsification is sufficient cause for reversal of a name change.
Signature (Required):
Date:
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Student Change of Name Form Preferred Name Form (Coconino Community College)

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Completed 2 February 2021

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