Change of Personal Data Request Form
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Change of Personal Data Request Form (24.7KB file)
The Change of Personal Data Request Form is used to request change of name and/or change of address and telephone number. This form is also available at the the Office of the Registrar. If you are not able to download the above form or visit our office to complete the form, requests may also be made in writing. Please include all of the following information:
- Full legal name (include any former names used while attending)
- Social Security number or student ID number
- Program and year of graduation (if applicable)
- Current address and daytime telephone number
- Date of request
- Requests must be signed by you. We cannot accept requests made by others on your behalf
- Requests may be mailed or faxed
Change of Name
The following additional information is needed for a change of name request:
- Former name (last, first and middle name or initial)
- New name (last, first and middle name or initial)
- A copy of the legal documentation that supports the name change must accompany the request. Legal documentation can include the following: naturalization certificate, marriage license, divorce decree, driver's license, social security card or passport.
Change of Address
To change your address and/or telephone number you will need to go to BanWeb and log in.
The following additional information is needed for change of address/telephone number requests:
- The date the change should be effective
- The mailing address/telephone type that is being changed (mailing, permanent or emergency contact)
- The new complete address (street address, city, state and zip)
- The new telephone number (including area code)
- If the change is for emergency contact, list the contact name and the relationship to student for example: mother, spouse
- If you are an international student, please indicate this on your request
- All University departments will have access to the updated information through the Banner SCT Student Database System.
- The Family Educational Rights and Privacy Act of 1974 (FERPA) allows Western University of Health Sciences to release certain directory information about students without written consent. This information includes, in part, name and address/telephone information. To view more information about FERPA, please visit our Student Privacy Rights page.