FOR OFFICE USE ONLY
Distribution for Name Change:
Student / Alumni Name Changes Registration
Faculty / Dean Name Changes Dean’s Area
Staff / Hourly Employee Name Changes Human Resource Services
Name changes via Social Security Card Human Resource Services if individual is employed by the college
Banner updated on:
By:
Paper file(s) updated on:
By:
Revised 10/31/17
REQUEST FOR NAME CHANGE FORM
Instructions for students or alumni
(not currently a faculty or staff member):
You must complete this form and provide
one of the following pieces of
identification in person, by fax
(360.867.6680) or scanned and emailed
to registration@evergreen.edu.
Instructions for faculty or staff: You must appear in person
and provide photo identification as proof that you are the
person whose name is being changed. If the photo
identification presented is not one of the documents listed
below, one of the following must be presented as proof of
name change. A photocopy of the documentation will be kept
along with this form.
Valid Driver's License Social Security Card Marriage Certificate or License
Passport Court Order Valid Military ID
Valid State ID Birth Certificate US Bureau of Indian Affairs ID
Federally recognized Indian Tribal Enrollment Card
Check all current associations with the college:
Student Alumni Classified Staff Exempt Staff Temporary / Hourly Employee Faculty / Dean
NAME CHANGE
A #:
Effective Date of Change:
New Name
First:
Middle:
Last:
Former Name
First:
Middle:
Last:
Signature:
Update Addresses and Phone Numbers at my.evergreen.edu
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