Official Name Change Form
NOTE: Form must be typed. Handwritten copies will not be accepted.
This form contains interactive fields allowing for online completion.
Please print the name you wish to appear as your official name on record:
Two (2) forms of documentation from the following list are required for processing:
Social Security Card
If you have applied for graduation and would like to change your diploma or certificate to reflect
this name change, please check the appropriate box: Yes No
Are you currently enrolled?
If no, last semester at USM:
Complete and return to The University of Southern Mississippi Registrar's Office
118 College Drive Box 5006 Hattiesburg, MS 39406
Phone: (601) 266-5006 Fax: (601) 266-5816