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Athletic Training
Name and Address Change

To request an address change, you may contact any staff member at (402) 471-2299, submit an Address Change Request to our office, or submit a request via e-mail to jacye.lafayette-dymacek@nebraska.gov.
 
To request a name change, you must submit an pdf icon Affidavit of Name Change with your notarized signature and a copy of the legal document verifying your name change to:
 
Department of Health and Human Services
Division of Public Health – Licensure Unit
PO Box 94986
Lincoln NE  68509-4986

 

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