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Personal Record
Change of Name
Change of Name
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Unique/Student ID
Date of Birth
(mm/dd/yyyy)
Name as it currently appears on your University record:
First Name
Middle Name
Last Name
New Legal Name:
First Name
Middle Name
Last Name
Attachment
Documentation must be included with this form to verify a legal name change (e.g., marriage license, court documented name change).
Attachment
File attachments associated with the ticket.
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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.
Acknowledgement:
Acknowledgement:
I agree.
Other Fields
Your name
Your first name
Your last name
Your email address
Verification Code