Use this form to change the following:  address, major, social security number, or name.
Any items that are marked with an asterisk (*) are required.

* Student Name		* Date
* Student ID #:		* Home Campus

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ADDRESS CHANGE
Old Address City State Zip Phone Number   E-mail address	New Address City State Zip Phone Number   E-mail address

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PROGRAM CHANGE (Transfer will move all academic information from one program to another. Do Not transfer any program you intend to complete. Add will allow you to track more than one program.)
Transfer from:	MBA    MM    MSN	Emphasis:
Transfer to:	MBA    MM    MSN	Emphasis:
Add additional program:	MBA    MM    MSN	Emphasis:

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SOCIAL SECURITY NUMBER CHANGE
Incorrect Number		Correct Number
NAME CHANGE
Previous Full Name		New Full Name
Explanation
In order to change name or social security number, this form along with a copy of the legal document must be mailed or faxed to the Office of the Registrar at the address/fax number indicated below NAU - Distance Learning 5301 S Highway 16, Suite 200 Rapid City, SD 57701 FAX (605) 394-5082