Name Change Request Form

Student ID or Last 4 SS#*

Previous Name Used at College*

First Middle Last

New Name*

First Middle Last

Email*

Required documentation*

Two required forms of identification are attached to this request

Government issued photo identification AND
Marriage certificate or Divorce decree or Order granting a name change provided by a court of competent jurisdiction or Social Security card*
*Please physically bring a copy of your Social Security card and government issued photo identification to the Office of the Registrar in Room 113.

Government issued photo identification*

Max. file size: 50 MB.

Second form of required identification (from list above)*

Max. file size: 50 MB.

Change in Marital Status (used for reporting purposes only)

Married
Divorced
Widowed

Consent*

I hereby certify that by selecting the “I Accept” button, I am signing this request form electronically and that my electronic signature is the same as my handwritten signature.