Request for Change of  Name

*In order to petition for a change of name you must complete this form.  Supporting documentation is required.
 

New Name ______________________________________________
Former Name ______________________________________________
Current ID # ______________________________________________
Anticipated Graduation Date ______________________________________________
   
Reason For Name Change ______________________________________________________________

_______________________________________________________________________________________

Marital Status ____ Single ____ Married (Used for summary reporting only)
Birth Date ______Month  _______ Day _______Year
   

How can we reach you if we have questions:

Email Address: ______________________________________________
Daytime Phone: ______________________________________________
   
Student Signature ______________________________________________
Date ______________________________________________
   
supporting documentation
  • Copy of legal documentation, such as a copy of a social security card (only if submitting by mail; do not fax the SSN card), copy of a marriage certificate, or official court document that supports the name change along with a a photocopy of the student's drivers license, state id, or other acceptable form of photo id which displays the birthdate.
  • If you are or have ever been employed by Indiana University, even as a work-study employee, please provide documentation, such as a photocopy of your driver’s license. If you are or were an IU employee and your marital status has changed, please provide a copy of appropriate documentation. This will be used in adjusting any employee benefits. Contact Human Resources with any questions.
Fax, mail or bring the completed form to one of the addresses below.
Fax to: 317-278-2240
Mail to: Visit us at:
Office of the Registrar
Cavanaugh Hall, Room 111
425 University Boulevard
Indianapolis, Indiana 46202-5143
Office of the Registrar
Campus Center, Suite 250
420 University Boulevard
Indianapolis, Indiana 46202-5144
Copyright - The Trustees of Indiana University