1903 W. Michigan Avenue
Kalamazoo, MI 49008-5256
(269) 387-4300
Legal Name Change Adavit
An individual seeking an ocial name change for his/her University academic records must be a current student. If a
name change is requested during a semester, it is the student’s responsibility to notify the instructor(s) to ensure the
proper assignment of grades. Complete this adavit and return to the Registrar’s Oce, along with a copy of the legal
Former name (First): (Middle): (Last): WIN:
New name (First): (Middle): (Last):
WMU email address: Phone number: Date of birth:
One of the following legal documents must be submitted with the adavit:
Marriage license
Decree of divorce
Court order specifying name change
I understand that all university academic records and correspondence will reect the new legal name provided above. I certify
that the information I have provided is true and correct. I also arm that this change of name will not be used for fraudulent
Student signature: _____________________________________________________ Date: _____________________
Sign ONLY in the presence of a Notary Public.
With my signature, I verify the identity of the person above and can attest to the validity of the legal documentation. A copy
of the legal documentation is enclosed.
 
 
Sworn and subscribed before me this day of ,
Notary Public
Return to:
Oce of the Registrar (Seibert Administration Building, 3rd Floor)
1903 W. Michigan Avenue
Kalamazoo, MI 49008-5256