Fillable Namechangerequestform2pdf Name Change Request Form (Ball State University)

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Namechangerequestform2pdf Name Change Request Form (Ball State University)

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NAME CHANGE REQUEST FORM
** A copy of the driver’s license, marriage certificate, or court papers,
Ball State University
Office of Registrar
B-43 Lucina Hall
with the changed name must accompany this form
Muncie, IN 47306
registration@bsu.edu Phone: 765-285-1722 Date _______________
* Ball State ID
number
Date of Birth
Phone No.( _____)-______-_______ Last term at BSU__________
**************************Change the following information************************* Change
FROM: Former Name (PLEASE PRINT)
___________________________________________________________________________________________
Last First Middle
Change TO: Current Name (PLEASE PRINT)*
_________________________________________________________________________________
First
All Former names _____________________________
Last
Middle
I authorize the name change on my Academic Record as specified above.
Signature___________________________________________________________________________________
Please provide if you remember
By Marriage By Court Birth Certificate
This form along with documentation in PDF format may be emailed to registration@bsu.edu
_________________________________
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Namechangerequestform2pdf Name Change Request Form (Ball State University)

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Completed 28 January 2021

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