Appendix 10 Revised 9/2015 WEST VIRGINIA DEPARTMENT OF EDUCATION HIGH SCHOOL EQUIVALENCY REQUEST TO CHANGE INFORMATION ON EXAMINEE’S RECORD I, , give the West Virginia Department of Education High School Equivalency Office Staff permission to make changes to my High School Equivalency record. I am sending the appropriate documentation to show proof of the following requested changes to my Social Security number, name (spelling errors only), and/or date of birth. I understand that this documentation is required before changes can be made. Address changes can be made at any time with this signed release form. All requests must be accompanied by a copy of a current government-issued photo ID. Last Name Social Security Number Date of Birth First Name Please make the following corrections to my High School Equivalency record. *Name (spelling error only) Attach copy of Birth Certificate Social Security Number Attach copy of Social Security Card Date of Birth Attach copy of Birth Certificate Address Signature of individual requesting changes Telephone number (in case of questions) I understand that I will only be contacted if there is a question about my request. Otherwise, I should see the changes in the High School Equivalency record. *The only time a name change is made is if the examinee has not passed the test and a birth certificate or marriage license is provided as documentation along with s State or Government photo ID. If the name is misspelled or the date of birth is wrong on the State of West Virginia High School Equivalency Diploma, the graduate must return the diploma with the errors and provide documentation of a birth certificate along with a State or Government photo ID. The only way a name change can occur once the HSEA has been passed is through a court order; changes are not made due to a marriage once the test has been passed. Please fax or email this completed form with the required photo ID and documentation to the TASC Office at 304-558-4874 or [email protected] For questions, call 304-558-6315.