Name as it currently appears on your University record:

New Legal Name:


Documentation must be included with this form to verify a legal name change (e.g., marriage license, court documented name change).
File attachments associated with the ticket.

Read and Agree to the Following Statement:

I certify that the information submitted is authentic and true.
It is further understood and agreed by me that if any of this information is found to be false I may be subject to the imposition of such disciplinary sanctions up to and including suspension, dismissal, or the imposition of reasonable fines.

Other Fields

Your name
Verification Code