Name Change Form

Please fill out the form fully and submit all necessary documents in order for our office to process your name change request. Please send a copy of your Driver's License and Social Security Card to records@nccc.edu immediately after completing the form (it will not be processed until we get). Call 518-891-2915 ext. 1689 or email records@nccc.edu with any questions.

If you see this don't fill out this input box.

First Name*

Middle Initial

Last Name*

New Name:*New Name:

E-mail Address*

Phone Number*Phone Number

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*Enter your full name.

Date*Enter today's Date