Name Change Request Form

Candidates holding credentials through the National Healthcare Certification Organization may request a name change for previously issued certification documents. Name Change Request Forms must include proof of identification and evidence supporting the name change.

Supporting documents may include:

• Marriage or divorce documentation
• Current driver’s license
• Social security card
• Passport or naturalization paperwork
• Official court documents

Candidates will receive a response via email within 30 days of submitting a Name Change Request Form.

The Name Change Request Form fee is non-refundable.