Response

Primary Contact

Prefix

First Name

Last Name

Address Line 1

Address Line 2

City

State

Zip

Phone

Requested Activity I need to change my address/phone #(s), email address
I need password/login assistance
I want to set up/change/stop my automatic withdrawl payments
I need assistance on using my Prepaid Tuition benefits
I am currently using my benefits and want to change schools
I need assistance on how to enroll into the Prepaid Tuition Program
I want to cancel my Prepaid Tuition contract
Other

Other Request

Further Information of what is requested (if needed)

Prepaid Tuition Contract Number (if known)

Last four numbers of your Social Security Number (if contract number is not known)

On the Prepaid Tuition Contract are you listed as: Purchaser
Beneficiary (student)
Legal Successor

Is the Prepaid Tuition beneficiary (student) currently using their benefits: Yes
No

Where benefits are used Benefits are being used at a Nevada System of Higher Education (NSHE) institution
Benefits are being used at a private/out of state institution

Demographic Information

Are you: Parent
Student
Other

Have you graduated from college? Yes
No
Prefer not to say

Are you a first generation college student? Yes
No
Prefer not to stay

How do you identify? Male
Female
Prefer not to stay

What are your preferred pronouns? She, Her, Hers
He, Him, His
Other

Other

Are you Hispanic, LatinX, or of Spanish origin? Yes
No
Prefer not to say

What is your household size?