Name Or Data Change University Of California Santa Barbara printable pdf download

Office of the Registrar

University of California, Santa Barbara

Santa Barbara, CA 93106-2015

PETITION FOR NAME OR DATA CHANGE

University of California

Phone: 805-893-3592

FAX: 805-893-2985

Santa Barbara

Name: __________________________________________________

Perm: ___________________________

Last

First

Middle

Student Status:  Undergraduate  Graduate  Non-Current

Important Information:

Perm number is required. If you do not know or cannot recall your Perm number, please contact the Office of the

Registrar.

All changes must be accompanied by applicable documentation including but not limited to:

● Marriage License ● Driver’s License ● Court Order ● Government-Issued ID ● Social Security Card ● Passport

Name change must be the full legal name. Nicknames, abbreviations, or initials are not acceptable unless used as legal

name.

When providing documentation, please provide photocopies. Do not send originals.

UCSB aims to serve students coming from all genders, gender identities, and gender expressions. Students who have

needs or questions specific to ones gender and/or name used on university records can meet with the Director of LGBT

Resources (805-893-5847) or the Associate Registrar for Academic Records (805-893-8653). Each student has the

opportunity to meet with a staff member to discuss how the University may assist the student.

Instructions:

Select the field below that is incorrect and provide the correct information (right column). DO NOT fill out any other

fields except the one that needs to be corrected.

Sign and return this form with supporting documentation to the Office of the Registrar. Please note that no

documentation is necessary to correct the Ethnic Origin field.

Select ONLY the field that

Provide the correct information, for selected field ONLY

is incorrect

 Name

Current in System: _______________________________________________________

Last Name

First Name

Middle Name

Change to: ______________________________________________________________

Last Name

First Name

Middle Name

 Social Security Number

Do not list your SSN. Attach a copy of your Social Security Card with this form.

 Date of Birth

(MM/DD/YYYY)

 Place of Birth

(City, State, Country)

 Ethnic Origin

 American Indian/ Alaskan Native (C)  Black/ African American (A)  Chicano/ Mexican American (E)

(Select one)

 Chinese/ Chinese American (2)  East Indian/ Pakistani (R)  Japanese/ Japanese American (B)

 Korean/ Korean American (X)  Latino/ Other Spanish American (5)  White/ Caucasian (F)

 Pacific Islander/ Micronesian/ Polynesian (M)  Pilipino/ Filipino (L)  Other Asian (D)

 Other (D)  Decline to State (G)



 Gender

 Female

Male

(Select one)

Student Signature: __________________________________________

Date: _____________________

E-mail:_____________________________________________

Phone: ______________________________

Office of the Registrar Use Only:

Documentation verified by: ____________________ Date system updated: ____________________________

J:Registration,Readmits,Spec. programsData (Forms, Reports, Etc.)Registrar Forms and Petitions

Revised 08/25/2016 SS

Name Or Data Change University Of California Santa Barbara

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