Name / Contact Information Change Form

1. Name / Contact Information Change Form

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* 1. What information would you like to update?

Legal Name Change

Address Change

Email Address Change

Phone Number Change

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* 2. Complete the contact form with your MOST CURRENT information

Your First and Last Name. *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number *

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* 3. Is your legal name different from the one in the school's record?

No

If different, enter the name you had while in your program?

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* 4. If your current legal name is different, please upload a name change supporting document

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

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* 5. Enter Your SS# or UMI Student ID

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* 6. Name of the Program you attended at UMI

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* 7. When did you begin your program?

Date / Time

Date

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* 8. When did you graduate or leave the program?

Date / Time

Date

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* 9. By selecting "Yes", you attest that you are an authorized student or graduate completing this form on your behalf.

Yes