If you are a foreign national student, International Services at CGS101 must pre-approve* this change of name
request before submission to the University Registrar’s Office for processing.
Do you want this change of name to appear on your upcoming (for potential graduates) and/or
duplicate/replacement diploma?
Yes No
Current Name
Last Name ___________________________________________________________ Middle Name ___________________
First Name ___________________________________________________________
Previous Name
Last Name ___________________________________________________________ Middle Name ___________________
First Name ___________________________________________________________
USFID Number ________________________________________ Phone ________________________________________
Current Address
Address _____________________________________________________________________________________________
City ___________________ State __________________ Zip Code ___________________
Reason for Change
Check appropriate box and attach copy of legal documentation for justification
Marriage Legal/Court Order Other (explain)
Divorce Misspelling Correction
*International Services
Approval Signature
URO Staff Initials &
Date Processed
Student Signature ________________________________________________________ Date _______________________
Change of Name
Request Form
Office of the Registrar
Tampa Campus
4202 E. Fowler Ave., SVC 1034
Tampa, FL 33620
St. Petersburg Campus
140 7th Avenue S., BAY 102
St. Petersburg, FL 33701
Sarasota-Manatee Campus
6350 N. Tamiami Trail, SMC C107
Sarasota, FL 34243
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