Name Change Request Form

Name Change Form

Fill out the form completely (all fields are REQUIRED) and attach all necessary documents (Driver's License and Social Security Card) in order for the Registrar's Office to process your name change. Any questions contact the Registrar's Office at records@nccc.edu or call 518-891-2915 ext. 1689.

First Name (Current)

Middle Name/Initial

Last Name (Current)

New Name

Birthdate

NCCC Email

NCCC Student Email Address

Phone Number

Phone Type

Upload a copy of your Driver's License.

Upload a copy of your Social Security Card.

Verification

I am the individual submitting this name change request. I understand, that by signing this name change form, I am formally requesting this change.

Signature (please type your full name):