NAME CHANGE

Name change is processed with a written request to include marriage license, divorce papers, birth certificate or court papers and picture identification or driver license. Submit documents to the Admissions and Records office FAC 216   Request will not be processed without proper documentation and signature.
State law requires that you be informed of the following:  (1) you are entitled on request to be informed about the information that is collected about you by use of this form (with few exceptions as provided by law); (2) you are entitled to receive and review the information; and (3) you are entitled to have information corrected at no charge to you.
 
SSN: Date of Birth:  
Date:
Former name:
Last First
Current name:
Last First
E-mail address Phone number
Type of legal document submitting:
Birth certificate
 Divorce papers Marriage license
   
Signature: _____________________________________________
Do not write below this line
       
Date Changed: ________ Initials: ______ Instructor: ________ Class section: _______ Date Notified: ________ Initials ______
Date last updated 09/21/09