CHANGE OF NAME

							                                            Application for Student Change of Name
                              (Currently Enrolled Students Only* or Admitted For A Future Term)
                                               ARIZONA STATE UNIVERSITY
                                               UNIVERSITY REGISTRAR’S OFFICE
Please Type or Print. Also see additional instructions below.                                                                               Rev. 1/15/2008
I certify that all the information supplied by me is this application is correct and complete; and I also understand that any misrepresentation of
falsification is sufficient cause for reversal of a name change and/or cancellation of enrollment and could result in other disciplinary action.
ASU I.D. NO.                         BIRTHDATE (MO., DAY, YR.)               STATUS (CHECK EACH APPLICABLE BOX)
                                                                                  Currently enrolled at ASU           Applying for ASU readmission
                                                                                  New incoming ASU student            Applied for ASU graduation
                                                                                  Currently employed at ASU (see below note)**
NAME CURRENTLY ON ASU RECORDS ***
LAST                                                    FIRST                                                        MIDDLE


NAME CHANGE REQUESTED ***
LAST                                                    FIRST                                                        MIDDLE


ADDRESS                                                                                  CITY                               STATE        ZIP


PHONE NO.             E-MAIL ADDRESS               VISA STATUS see “d” below             STUDENT SIGNATURE                                      DATE


*      Historical academic records for formerly enrolled students will not be altered, unless related to gender changes as described below.
**     Please note, Human Resources name changes will override the Registrar's Office name change process. Therefore, students who are currently
       employed at ASU must submit a name change through ASU Human Resources, USB.

Instructions:
1. All requests require:
    a. student's signature
    b. picture identification (if submitting via mail or fax, include copy of picture identification)
    c. copy of one of the following documents verifying the name change:
               marriage license/certificate
               adoption papers
               court order
               divorce decree
               social security card
   d. all foreign passport and permanent visa holders must submit a copy with request.
   Students with F1 or J1 Visa status must process name changes through the International Student Office at
   480-965-7451.
(If the name change also requires a gender change on academic records, a court order supporting the request is required. Name
changes related to gender changes may be processed for formerly enrolled students.)

2. Students may submit an Application for Student Change of Name request form to:

                              Downtown Phoenix campus            Polytechnic campus                Tempe campus                     West campus
In person:                   Enrollment Services                 Enrollment Services               University Registrar's           Registration Services
(Bring Photo ID)             UCENT, Suite 166                    Std Affairs Complex, Bldg 350     Office                           UCB 120
                                                                                                   SSV 144

By Mail:                     Enrollment Services                 Registration Services             Academic Files                   Registration Services
(Include Copy of Photo ID)   411 N. Central, Ste. 166            7001 E. Williams Rd.              PO Box 870312                    PO Box 37100
                             Phoenix, AZ 85004-2120              Mesa, AZ 85212                    Tempe, AZ 85287-0312             Phoenix, AZ 85069

By Fax:                      602-496-0376                        480-727-1008                       480-965-2295                    602-543-8312
(Include Copy of Photo ID)



3. Please call Academic Files at (480) 965-7276 with any further questions