Rutgers - The State University of New Jersey
Office of the Registrar
CHANGE OF NAME FORM
Read the “Statement of Policy on Student Name Changes on University Records” on the previous website before completing this form.  This form is used for changing your name of the University’s record.  Do not use this for correcting or adjusting the spelling or format of your name.  (Please Print)
1.   Current Name:__________________________________________________________________________________
                                                       Last                                  First                             MI                SUFFIX (Ex. Jr., III)
    Requested Name:________________________________________________________________________________
                                                       Last                                  First                             MI                SUFFIX (Ex. Jr., III)

    Social Security Number:_____________________Telephone #_____________________________________________

2.   If currently enrolled, complete the following:

 Student I.D.:____________________Current School of Attendence:__________________________________________

 Other Rutgers Schools of Attendance:__________________________________________________________________

3. If not currently enrolled, complete the following:

 Last School of Attendance:__________________________________________________________________________

 Other Rutgers Schools of Attendance:__________________________________________________________________

 Degrees Awarded:_____________________  Schools:____________________________________________________

4. Attached is a copy of my:    _____Driver's license    _____  Social Security card ____ Voter Registration card

____ Marriage  License   _____ Court Order 

5. Statement by  Student:
 I affirm that the request for a change of name on the University Registrar’s records has no fraudulent or criminal 
purpose.

 _________________________________________________             _____________________
                                  Signature                                                                                                  Date

**************************************************************************************
For Registrar’s Office Use Only

Maintenance completed:____________Permanent Record Card corrected:__________________
                                                   (date)                                                                                      (date)
cc:  Alumni/Alumae Office - Degree Holders Only
      Dean of Students - Active Only
      Dean of College/School - Active Only
      Financial Aid - Active Only