Name or Address Change Form

Name or Address Change Form
Name (Please Print)
MUID (901#)
Date of Birth
Name Change Information (New)
Please note: You must still contact the main campus registrar’s office to officially change your name
with Marshall University. This form is only to change your name within the MUSOM system.
Please provide a copy of NEW Social Security Card with new name.
Previous
Please Print
New
Last Name:
First Name:
Middle Name:
Suffix:
(Jr, Sr, III)
Address Change Information (New)
Please note: You must still contact the main campus registrar’s office to officially change your address
with Marshall University. This form is only to change your address within the MUSOM system.
Address Line 1:
Address Line 2:
City:
State:
Home Phone: (
)
Mobile Phone:
Zip:
(
)
By signing below, I certify that the information provided is correct.
Signature
Date
PLEASE SUBMIT COMPLETED FORM TO OFFICE OF ACADEMIC AFFAIRS
FOR OFFICE USE ONLY
Date Received:
Received By:
Date Updated:
Updated By: