Student Legal Name Change Request
Documentation is needed for name changes (except if changing middle name to middle initial).
Documents submitted by mail must be notarized, with the following statement: This is a certified and true copy of the original
document. Do not mail original documents. Bring original document if submitting in person, copies will be made.
Examples of acceptable certified legal documents include:
In some cases additional documentation may be required. Social Security card is required for students employed by Kent
State University.
Marriage – Marriage Certificate, Court Order, Social Security card or valid U.S. Passport*
Divorce – Court Order, valid U.S. Passport*, Social Security card or Divorce Decree (must state name is restored to former
name)
Legal name change – Court Order, Adoption Order, Social Security card or valid U.S. Passport
First name change – Birth Certificate, Social Security card or valid U.S. Passport*
Student Information
Kent State ID Number or Social Security Number:
Last Date of Attendance:
Phone Number:
Date of Birth (mm/dd/yyyy):
Have you applied for graduation?
Yes
No
(Current students only)
CURRENT LEGAL NAME on record with the Office of the University Registrar:
If yes, what term:
Last
Middle
First
REQUESTED NEW LEGAL NAME to be filed with Office of the University Registrar:
Last
First
Middle
Important notes:
1. Current students should submit this form prior to their final semester to ensure name is updated on records,
commencement program and diploma.
2. Former students will not be automatically reissued new diplomas with the updated name. Visit our website at,
http://www.kent.edu/registrar/diploma-replacement for replacement diploma details.
3. If legal name change occurs during a term, the student is responsible for notifying instructors of the new legal name.
4. Students receiving financial aid must provide an updated social security card to the Student Financial Aid office.
5. *If non-U.S. passport is provided, a copy of your U.S. visa documentation is also required. Documentation must be in English
or have a translation on the form.
Return this form in person, by mail or email (do not fax):
In person to (photo ID required): Office of the University Registrar, 108 Schwartz Center, or to a Regional Campus Student
Services Office
Mail to: Office of the University Registrar, PO BOX 5190, Kent State University, Kent OH 44242-0001
Email to: gradsvc@kent.edu
I certify that all the information supplied by me on this form is correct and complete. I also understand that any misrepresentation or
falsification is sufficient cause for reversal of a name change, cancellation of enrollment and/or other disciplinary action.
Print Form and Sign - Handwritten Signature Required
Signature: ______________________________________________________Date:__________________
Regional Campus use only (if applicable): Campus: _________________________
Date Received:_____________ Received by (please print name):__________________________________________
Revised 5-11-2015
Registrar’s
Office use only: Date received:_____________ Received by (please print):______________________
Date processed:_________________________ Processor Name:__________________________________________