Fillable Legal Name Change Form printable pdf download

Legal Name Change Form

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California State University, Long Beach

Enrollment Services

Legal Name Change/ Name Correction Request

Submit this form with appropriate legal documentation (speciﬁed below) to the Oﬃce of Enrollment Services, BH 101,

to change your legal (primary) name in CSULB’s student records. Current and Former CSULB employees (including

student employees) can only change their legal name by presenting an original Social Security Card to the Payroll Oﬃce

in BH‐353, (562) 985‐4164.

Campus ID Number:

Current Legal Name on Record at CSU Long Beach:

Last:

First:

Middle Initial:

New/Corrected Legal Name:

Last Name:

First Name:

Middle Name:

Enrollment Status:

Former Student

Applicant

Current Student

Please provide your email address so

that we may contact you if necessary:

Name Change Documentation:

Name Correction Documentation:

Acceptable Legal Documentation—



Birth Certificate



Driver’s License

Document must state old and new name.



Marriage License



Passport



Certificate of Naturalization with Petition for



California Identification Card

Name Change



Adoption Record with new Birth Certificate



Divorce Decree (Stating restored name)



Court Order



Alien Registration Card

I declare that the information provided above is true and correct and represents a bona ﬁde change. This change of

name will not be used for fraudulent purposes.

Student’s Signature

Date

OFFICE OF ENROLLMENT SERVICES:

Processed By: ____________________________________

Date

Legal Name Change Form

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