UREG University of Virginia Applicant Name Change Form
Name Changes for Applicants who are Former Students.
Date School or SCPS Center to which you are applying
Previous Last Name: Previous First and Middle: I.D. Number:
New Last Name: (if different) New First and Middle: (if different)
Reason for Change:
A copy of a court order, driver's license, marriage certificate, passport, social security card, or some other official document showing the new name and /or number must accompany this form. Send form along with accompanying documentation to your school's admission office.
Signature: ______________________________________________________
For office use only: School Representative initials: ____________ / Approved Official Documentation (put X in box for approval)