Rutgers Change Of Name Form printable pdf download

Change of Name Form - Please Print

Office of the New Brunswick Registrar

ASB, Rooms 200B-Undergraduate or 200F-Graduate

65 Davidson Road

Piscataway, NJ 08854-8096

FAX: 732-445-5948

Please read the "Policy Statement on Student Name changes on University Records" before completing this form.

Use it only to change your name on the University's Official Records, not to correct or adjust the spelling or format

of your name. Two forms of identification are required.

Current Name in Records Now (Last, first, middle initial):_____________________________________________________

Requested New Name (Last, first, middle name/initial):_______________________________________________________

Student I.D. (RUID #):________________________________ Telephone #: ____________________________________

Current Address: ______________________________________________________________________________

______________________________________________________________________________

Email Address: ______________________________

Date of Birth: ____________________________

If currently enrolled, please complete the following:

Current School / College Attending: _________________________________

Other Rutgers Schools of Attendance: _________________________________________

If NOT currently enrolled, please complete the following:

Last School of Attendance: ______________________________________

Date Attended: ________________________

Other Rutgers Schools of Attendance: ________________________________

Date(s): ___________________________

Degree(s) Awarded and Year(s) Awarded: _________________________________________

I submit _________________________________ and _______________________________ (Driver's License, Passport or

Permanent Resident Card, Marriage License, Court Order, Social Security Card, etc.) to verify my name change.

STATEMENT BY STUDENT:

I affirm that the request for a change of name on the Rutgers University Registrar's Student Records Database has no

fraudulent or criminal purpose.

Signature: _______________________________________

Date: _____________________

__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

For Registrar's Office

Date Maintenance Completed:________

For Active Students, Contact: Dean of Students at College/School, Financial Aid Office, Business/Cashier Office

For Degree Holders, Contact: Alumni/Alumae Offices

Rutgers Change Of Name Form