Name Change Request

We are happy to assist you with updating your account information to reflect your new legal name. Please complete the form below with your information as it currently appears on your account, and then your updated legal name. If you need to make additional changes to your contact information, please do so through your My Account page before submitting this request. If you have a name change request that is not covered on this page, please contact the Action Center at 800-498-2071, Monday–Friday, 8:30 a.m.–5:00 p.m. ET.

* indicates a required field.

Current Account Information

Please provide your current information for verification purposes.

ASHA or NSSLHA Account Number*

First Name*

Last Name*

E-mail Address*

Mailing Address*

Address line2

City*

State

Postal/Zip Code*

Country

Is this your preferred mailing address?* Yes No

Updated Account Information

Please provide your updated legal name.

Preferred Prefix*

First Name *

Middle Name or Initial

Last Name *

Suffix

Would you like a new ASHA/NSSLHA card mailed to you?* Yes No

Disclaimer

By submitting this form, you are authorizing a change to your ASHA or NSSLHA account information. Please note, if you are a certificate holder, this change will affect how third parties search for and verify your credentials with ASHA.

I Agree*

Name Change Request

Current Account Information

Updated Account Information

Disclaimer

ASHA Corporate Partners

About ASHA

Information For

Get Involved

Connect With ASHA

Media Resources