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Request for Change of Name

Please note that in order to submit your request electronically, you must attach supporting documentation. If you are unable to do so, please print the Change of Name Form and either fax or mail the completed form and a copy of your supporting documentation (see below) using the contact information at the top of the form. Both documents must be received together.



Former Name



New Name



Emergency Contact Information
If you would like to update your next of kin/emergency contact on record at CSC, please provide the following information:



Supporting Documentation
Chadron State College must take reasonable steps to assure the name used by a student on educational records is the student's legal name. You must present a copy of one document {driver's license, social security card, certified marriage license, certified divorce decree or court order} that proves the establishment of a new name.
Attach supporting document. (Limit upload size to 15MB)
I authorize Chadron State College to update my permanent student record. I verify that the above information reported is complete and correct.




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