University Of Denver Name Change Request Form
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1Name Change Request Form
Use this form to request the University of Denver to change your name on official records. Required documents and
processing instructions vary depending on your relationship to the University. Complete the form; attach required
documents; and submit according to the instructions below.
University Employees. A Social Security card reflecting your new name is required. Bring this form and your Social
th
Security card to the Office of Human Resources, Mary Reed Bldg., 4
Floor. Call 303.871.7420 for additional
Information. We will contact your insurance providers for you as well. Please contact your retirement fund providers
directly to inform them of these changes
Students or alumni with current financial aid or Perkins loans. A Social Security card, court order, marriage license or
passport is required. This form along with documentation should be sent to the Office of the Registrar, University Hall
Room G33, 2197 South University Boulevard, Denver, CO 80208. The form may be faxed to 303.871.4300. Call
303.871.4095 for further information.
All other students and alumni. For last name changes due to marriage, only this form is required. For all other
changes a Social Security card, court order, or passport is required. This form along with documentation should be
sent to the Office of the Registrar, Attn: Name Changes; University Hall Room G08, 2197 South University Boulevard,
Denver, CO 80208. The form may be faxed to 303.871.4300. Call 303.871.2284 for further information.
Statement of Responsibility
I assume responsibility for the consequences or problems that may occur as a result of this change of my name.
There is no intent on my part to defraud the University of Denver.
Print Old Name
Print New Name
Other Previous Names
DU ID Number:
Social Security Number:
Date of Birth
Day Telephone No.:
Mailing Address:
City, State, Zip Code:
Signature
Date:
Check all that apply:
Student
Employee
Alum
Most recent degree
program
Graduated?
Yes
No
Current Perkins loan or current
Dates of Attendance:
DU financial aid?
Yes
No
Health Insurance Provider
Dental Insurance Provider
(employee)
(employee)
Office Use Only:
Processed by __________________________
Department ______________________ Date: _______________________
Processed by __________________________
Department ______________________ Date: _______________________
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Parent category: Legal