Fillable Change of Name Form Office of Records & (University of Wisconsin - LaCrosse)

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Change of Name Form Office of Records & (University of Wisconsin - LaCrosse)

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Change of Name Form
Office of Records & Registration
To officially change your name on UW- La Crosse records, please complete this form
and return it along with documentation (examples include a copy of legal document, your
new social security card or a valid driver’s license indicating your legal name).
Former Name ID Number (student ID or SSN)
Name changed to (please print)
Effective date of change (mm/dd/yyyy)
Phone Number (including area code)
Are you currently enrolled at UWL?
Yes
No
Are you currently employed by the university?
Yes
No
(If yes, you must take your new social security card to HR for processing of payroll information)
_______________________
________________ _______________________
Signature Date
Check here if you wish to have your campus email address reflect this change.
Current
students make sure to change your Student ID Card in 1113 Student Union.
Mail c
ompleted form
& docume
ntation to:
UW- La Crosse Records & Registration
117 Graff Main Hall
1725 State St
La Crosse, WI 54601
______________________________________________________________________________________
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Change of Name Form Office of Records & (University of Wisconsin - LaCrosse)

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Completed 24 July 2020

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