_________________________________________ ___________________________________________
_________________________________________ ___________________________________________
_________________________________________ __________________________________________
Return completed form to the Registrar’s Office
Plant Hall 90
(813) 253-6251 Fax: (813) 258-7238
Change of Name
This form must be accompanied by a photocopy of an acceptable legal document reflecting the new name.
Acceptable legal documents are a marriage license or court order. Documents that are not considered
acceptable legal documents include a driver’s license, a social security card, or notarized statement.
**using black ink is recommended**
Student’s Previous Name (Last, First, M.I.)
Student’s Current Name (Last, First, M.I.)
ID Number
Personal Email Address
Phone Number
Check here if you are a recipient of veterans educational benefits
Check here if you are studying on a student visa
I certify that I am the above named person and the information I have provided is accurate.
Signature Date
Revised 3/2015
click to sign
click to edit
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome