STUDENT LEGAL SERVICE
AO CASE INTAKE
NAME CHANGE
http://www.odos.uiuc.edu/sls
NOTE: This form is to be used if you would like to change your name. You are
strongly advised to read our informational brochure, "Want to Change Your
Name?" There is a link on the page where you found this document. For issues
other than changing your name, you will need to return to that page and select
the appropriate form to fill out.
THIS BOX FOR OFFICE USE
ONLY
Appt
Date: ________ Time: _______
ATTY:
TEB
SYH
JDG
Type: ____________________
Students who are assessed and pay the S.O.R.F. fee are eligible to consult Student Legal Services during the
semester that the fee is assessed, until the first day of the next term, including summer.
Once the form is completed, you must print it and bring it into the Student Legal Service Office, during regular
office hours (8:30am-Noon, 1:00-4:30pm) at 324 Illini Union and present it with your I-card. You will then be
set up with an appointment to discuss your issues with an attorney. This form may be destroyed in five (5) years.
What is your year/class at UIUC?
Family Name
First Name
Middle
LOCAL ADDRESS:
Dormitory (select)
Room #
Freshman
Sophomore
Junior
Senior
Graduate
Law/Med/Vet
Have you used Student Legal Service
previously?
If not, how did you learn
Yes
No
about Student Legal
Service (select one)?
OR
May we contact
you by e-mail?
Street Address:
Be sure to include
apartment # & city
Yes
@uiuc.edu
Zip Code
Local Landline phone #
No
Other e-mail:
Cell Phone #
What is your College at UIUC?
UIUC Office phone #
Major?
Permanent Address:
Permanent Phone Number:
Street address,
City, State, Zip Code
REQUIRED:
Are you a U.S. Citizen?
Yes
No
The following information is necessary for the attorney to prepare the documents to petition the court for a
name change. You will first meet with the attorney, before such documents are prepared.
Your ENTIRE current legal name:
Your date of birth:
(mm/dd/yyyy)
Full name you wish to change to:
Have you lived in the State of Illinois for at least six
months? (This is a requirement to change your name)
YES
Are you required to register as a sex offender anywhere?
(This questions is also a requirement to change your name.)
Your Place of Birth :
(city/
state or city/country, if not U.S.A.)
NO
YES
NO
I am a student currently enrolled for the current semester in credit-bearing courses of at least six hours, or
equivalent, at the University of Illinois at Urbana-Champaign
I have been assessed the S.O.R.F. fee of FOURTEEN DOLLARS ($14.00) and have not sought a refund of the SORF
fee at the University for the current semester. If I obtain a refund of anySORF fee while I am consulting with or
being represented by an attorney at Student Legal Service, I understand that I can no longer be represented.
I acknowledge being advised through this form and specifically agree that the Attorneys at Student Legal
Service act independently of the University of Illinois; the Attorneys are neither a part of nor agents of the
University of Illinois.
I understand that this form may be destroyed in five (5) years.
Date:
Signature:
(Please sign after you print the form)
NOTE: The printed form may be destroyed in five (5) years.
Print Form