Student Name
Change Form
Student
ID #:
Guilford Technical Community College
P. O. Box 309, Jamestown, NC 27282
Directions: Submit to Enrollment Services an Official State or Federal Photo ID along with an
original
or notarized copy of one of the following: birth certificate, valid U.S. Passport, marriage license,
original divorce decree that includes a specific decree granting restoration of the maiden or other name,
court order signed by judge, or Certificate by Naturalization. Documentation is required.
Reason For Name Change: ( ) Citizenship by Naturalization ( ) Correction
( ) Marriage* ( ) Divorce* ( ) Court-Action*
* Documentation must be attached
Incorrect Name: (please print)
(First) (Middle) (Last)
Contact Phone #:
Date of Birth:
Correct Name: (please print)
(First) (Middle) (Last)
Authorization - Please read and sign: The information on this form and the attached documentation
represent accurate and legally acceptable proof of my name. Please change all records to reflect this name.
Student’s Signature:
Date:
For Office Use Only:
This form must be submitted to the Enrollment Services Office with appropriate documentation
and signed by the person that accepts the form. Staff Person that received information:
Name:
Office:
05/18
click to sign
signature
click to edit
![]()
