Name Changes

Initiation of a name change must be documented by presentation of the following: court order, marriage license or divorce decree (Photocopy will be accepted).  If documentation is not available, two (2) other documents showing new name (driver's license, social security, passport, etc.) may be accepted.  This information must be presented to the Academic Services Office or authorized representative.

One exemption of this policy notes a woman's right to retain her maiden name.  In cases where our records indicate a prior name, the change may be made without documentation.  When no record of maiden name is indicated, a copy of the marriage license must accompany the request for name change.

Social Security Number Changes

Initiation of a social security number change must be documented by presentation of a Social Security Card to the Academic Services Office or authorized representative.

1. Print this form
2. Fill in all applicable/required fields. Print all information, please
3. Mail, Fax or Deliver to the Academic Services Office in Patrick Henry Center, Moon Campus
4. This area must be completed for any change requested.

Social Security Number:

Last Name: 

First Name:

Middle Initial:

Mailing Address:

City:

State:

Zip:

Phone Number: 

Use this area to change your name

Last Name:

First Name:

Middle Name/Middle Initial:

Use this area to change your Social Security Number

I hereby verify that I have read and understood the information provided above, and that the information I have provided is true and correct to the best of my knowledge.

OFFICE USE ONLY