Non-Credit Address/Name Change

* = required field

Some content may be updated based on selection

Non-Credit Address/Name Change

DMACC ID or SS#:

Legal Name - DMACC Records:

Last Name:

First Name:

MI:

DOB

Legal Name Change:

Last Name:

First Name:

MI:

Preferred First Name:

Address Change:

Street Address/Box#:

Apt.

City:

State:

Zip Code:

Telephone Number:

Home Telephone Number:
(###-###-####)

BusIness Telephone Number:
(###-###-####)

Cell Telephone Number:
(###-###-####

Current Email Address:

Please be aware that your DMACC email address will change as a result of this name change. The IT department will notify you of your new email address.

Emergency Contact:

Last Name:

First Name:

MI:

Relationship:

Street Address/Box#:

Apt.

City:

State:

Zip Code:

Home Telephone Number:
(###-###-####)

BusIness Telephone Number:
(###-###-####)

Cell Telephone Number:
(###-###-####

Any student wishing to make a change to their name may do so by submitting this completed form AND a copy of their valid drivers license. Other types of valid supporting documents that may be used if you do not have a valid drivers license include the following:

State ID
Birth Certificate
Marriage License
Military ID
Social Security Card
Legal Court Document

Supporting Documentation:
1. Click choose file
2. Browse PC to located scanned file
3. Click open to attach the file
4. Click Submit Form
or Choose File
(if you have additonal files to upload)

Please wait for files to finish uploading