NAME CHANGE FORM
PRINT NAME______________________________________________________________
LAST
FIRST
Required documents:
Driver’s license AND Social Security Card
(the names must match).
May substitute Passport, Court Order, or Birth Certificate for one
of the two documents.
Please return this form to the Registrar’s Office, Rusk Bldg., Room 202 along with the
required documentation. Notarization is required when mailing, emailing or faxing.
If you have filed for graduation, does this name change affect the name on your diploma?
Yes
No
Social Security Number:
Previous Name:
Change Name To:
Date of Birth:
/
Last
First
Middle
Last
First
Middle
Last Year Enrolled at SFASU:
Semester
/
Year
Contact phone number: (_____)__________________
SIGNATURE
DATE
State of Texas
County of __________________________
Before me, a notary public, on this day personally appeared ________________________, known to me to be the
person whose name is subscribed to the foregoing document and, being by me first duly sworn, declared that the
statements therein contained are true and correct.
Notary Seal:
Revised 9-5-14
____________________________
Notary Public’s Signature