Rev. 8/11/2019
REQUEST FOR NAME CHANGE
A current or former student may request a name change by completing this form. Please note the following:
Current students: in order to receive Title IV funds (financial aid), your name on record with MCW must
accurately reflect your current legal name on record with the Social Security Administration.
Former students: please update your name on record with Alumni Relations and Development via an
email to alumni@mcw.edu.
MCW employees: please update your name on record with Human Resources via the Name Change Form
available on the HR website.
All students: your current and former names will appear on the MSPE letter (medical students only) while
only your current name will appear on transcripts.
Former Name: _________________________________________________________________________
(Last name) (First name) (Middle name)
New Name: ___________________________________________________________________________
(Last name) (First name) (Middle name)
Program(s) of Study: ____________________________________________________________________
In order to complete a name change, at least one document from each category in the following list must be
submitted with this form. The documents must include the current legal name.
Category 1 Category 2
Court Issued Documents Driver’s License
Divorce Decree Government Issued Photo ID
Marriage Certificate MCW ID
Social Security Card U.S. Passport
Current students only:
Do you wish to also change your MCW email address and username?
If you check yes, MCW Information Services will contact you via MCW email or telephone.
Email: ____________________________ Mobile Telephone Number: (______)___________________
Medical Students: Do you wish to order a new white coat name badge?
The badge replacement fee is $20.00. Please attach exact cash or check made out to MCW with this form.
I verify the submitted documents are true and correct copies of the original documents.
Signature: _________________________________________________ Date: ___________________
Return this signed form to: or Return this form by emailing a PDF of the signed form to acadreg@mcw.edu.
Medical College of Wisconsin
Office of the Registrar, M3200
8701 Watertown Plank Road
Milwaukee, Wisconsin 53226
(414) 955-8733
