Legal Name Change Request Form - Minot State University printable pdf download

Legal Name Change Request Form - Minot State University

NORTH DAKOTA UNIVERSITY SYSTEM

Name Change Request Form

I hereby request that my name, as it appears on my student academic demographic record,

be changed as indicated below. All name change requests must be accompanied by the

corresponding legal documentation showing the change and a social security card

reflecting the new name. Examples of legal documentation include marriage license or

court documents. For international students, the passport name change documentation is

acceptable. This request will change the primary and preferred name on the student

academic record. All changes to payroll records (primary name) must be made with the

payroll office.

Complete

Name __________________________________________________________________________

Last

First

Middle

Most Recent

Former Name ____________________________________________________________________

Last

First

Middle

Other

Former Names ___________________________________________________________________

Last

First

Middle

Birth Date ________________________ EMPLID ____________________________________

You will need to contact ITC if you would like to have your MSU email address and blackboard login

for online courses updated. Please contact the MSU helpdesk at 858-4444 if you experience any

problems or have questions. Contact the Photo ID office to obtain a corrected Student or Faculty/Staff

ID card.

Signature ________________________________________________ Date __________________

Updated 10/6/2016

Legal Name Change Request Form - Minot State University