Thomas Edison State University     

 


Please complete all required information below. When finished, click the Submit button* at the bottom of the form to transmit it to the University. Please notify your faculty mentor(s) of a change as soon as possible. Keep a copy of this form for your records.

*Important note if making a name change: The registrar will need an original or notarized copy of your marriage license, divorce decree or verification of legal name change. As an alternative to an original or notarized name change document, the registrar's office will also accept copies of three (3) separate documents verifying the name change, such as driver's license, Social Security card, passport, bank or pay stub. Therefore, do not submit this form electronically. Instead, print, complete, and mail the form with appropriate documents to:

Office of the Registrar
Thomas Edison State University
111 W. State St.
Trenton, NJ 08608

Fax (609) 777-0477

I. Student Information

Student Name*
(use original name if changing)
University ID Number *
Current Course Title(s) and Course Code(s)
Semester
E-mail Address*


II. Please specify changes required below (fill out only fields where a change is required).

NAME Change (See important note above about documents that are needed when making a name change.)

From:
To:


ADDRESS Change

From:
To:


TELEPHONE NUMBER Change

Home Phone From: To:
Work Phone From: To:
FAX Number From: To:

E-MAIL ADDRESS Change

From: To:

* Required Fields

For Office Use Only:

[ ] Recorded [ ] Filed