Get Change Of Name/address Request - Oregon.gov - Oregon

The Change of Name/Address Request form from the Oregon State Board of Nursing allows users to update their personal information on record. This guide provides clear, step-by-step instructions to help users complete the form accurately and efficiently.

Follow the steps to successfully complete your request.

1. Begin by clicking the ‘Get Form’ button to obtain the Change of Name/Address Request form and open it in your preferred editor.
2. In Section 1, indicate the type of request you are submitting by checking the appropriate box for either a name change or a change of mailing address. Ensure your selections are clearly marked.
3. Proceed to Section 2, where guidelines for required documentation are provided. If you are updating your name, prepare to include proof of the legal name change from the accepted documentation list. If only changing your mailing address, no additional documentation is necessary.
4. Complete Section 3 by entering your new contact details. This includes your last name, first name, mailing address, city, zip code, Oregon license or certificate number, type of Oregon license/certificate held, primary telephone number, date of birth, secondary telephone number, and email address.
5. Choose your preferred method of contact — telephone, email, or postal mail — by checking the appropriate box.
6. Sign and date the form in the designated areas at the bottom of the page. Your signature authorizes the information provided to be updated on file with the Oregon State Board of Nursing.
7. Once the form is complete, mail or fax it along with any required documentation to the contact information provided. The OSBN will process your request within 10 business days.
8. For your records, you may also download, print, or share the completed form once it is filled out.

Complete your Change of Name/Address Request online to ensure your information is current and accurate.