WEST LIBERTY UNIVERSITY
DATA CHANGE REQUEST FORM - NOTE: PLEASE ALLOW 24 HOURS FOR CHANGES TO BE MADE!
INSTRUCTIONS: Complete all requested information. Complete each section applicable to current request (s). If you are CHANGING YOUR NAME please mail or fax documentation to the Registrar's office. For name change substantial documentation is required such as: Divorce Decree, Marriage Certificate, or Court Order before any records will be offically changed. ONLY CHANGE THE DATA THAT NEEDS CHANGED ON YOUR RECORDS. Fax 304-336-8220
Student Type *
Name: *
Last, First, Middle or Maiden
Your answer
Date of Birth *
Your answer
Student ID Number *
Your answer
Home Phone Number *
Your answer
Cell Phone Number
Your answer
CHANGE OF PERMANENT ADDRESS
Street, P.O. Box (*NOTE: PLEASE MAKE SURE YOU FILL IN CITY, COUNTY, STATE AND ZIP CODE AS WELL)
Your answer
City
Your answer
County
Your answer
State, Zip Code
Your answer
CHANGE OF DEGREE TO:
Your answer
CHANGE OF MAJOR TO:
Please choose from list provided. ONLY USE THIS IF YOU ARE CHANGING YOUR MAJOR! You must declare a major after the first year of school. If you are undeclared after the first year you are ineligible for financial aid. IF YOU CHANGE YOUR MAJOR ONCE THE SEMESTER STARTS IT WILL NOT REFLECT ON YOUR RECORD UNTIL THE FOLLOWING TERM.
CHANGE OF MINOR TO:
Please choose from the list provided. ONLY USE THIS IF YOU ARE CHANGING YOUR MINOR!
CHANGE OF CONCENTRATION TO:
Please choose from the list provided. ONLY USE THIS IF YOU ARE CHANGING YOUR CONCENTRATION!
DON'T SEE THE MAJOR OR MINOR?
PLEASE INDICATE WHETHER MAJOR OR MINOR AND TITLE THAT YOU DO NOT SEE IN CHOICES ABOVE
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CHANGE OF SECOND MAJOR TO:
Your answer
CHANGE OF SECOND MINOR TO:
Your answer
CHANGE OF CATALOG TERM TO
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LIST EXPECTED GRADUATION DATE
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CHANGE OF ADVISOR TO:
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OFFICE USE ONLY
Date substantiating documents received/initial Date change(s) completed/initial
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For name change please type in new name and send in required documents.
Your answer
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