Fillable Name Change (Arkansas Tech University)

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Name Change (Arkansas Tech University)

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The Name Change (Arkansas Tech University) form is 1 page long and contains:

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Country of origin: US
File type: PDF

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Student ID Number
Date
Name Enrolled Under (Last, First, Middle, Other)
Change Name To (Last, First, Middle)
Student Signature
Phone Number
Are you employed by ATU (staff, faculty, graduate assistant, student worker, etc.)? Yes No
*If employed at ATU, you will need to first have your name change processed by the Human Resource Office.
When do you plan to graduate?
Spring
Summer Fall Year: ______________
Indicate how you want your name printed on your diploma:
Do you need to change your contact information? Yes No
If so, please specify your updated Address: and Phone Number(s):
___ ___ ___ - ___ ___ ___ - ___ ___ ___ ___
Home
Cell
Work
Other ________
___ ___ ___ - ___ ___ ___ - ___ ___ ___ ___
Home
Cell
Work
Other ________
You will need to see the Card Office if you wish to receive a new Tech ID.
To change your email address and OneTech and Blackboard login information, you will need to
contact the Help Desk at 968-0646.
Date Processed
Initials
Revised July 31, 2019
Do you need to change your biographical information? Yes No
Gender:
Male
Female
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Name Change (Arkansas Tech University)

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Completed 18 July 2020

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