Fillable REQUEST TO CHANGE ADDRESS/NAME OR ADD A PREFERRED (Florida Institute of Technology)

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REQUEST TO CHANGE ADDRESS/NAME OR ADD A PREFERRED (Florida Institute of Technology)

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Country of origin: US
File type: PDF

U.S.A. forms for Florida Institute of Technology

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NAME ______________________________________________________________________________________________________________________________________
Last First Middle
ID NO. ________________________________________ DATE OF BIRTH _________________________________ DATE _____________________________________
SIGNATURE _____________________________________________________________________________
I am currently (check one) ¨ Student ¨ Employee ¨ Student and Employee DAYTIME PHONE NO. ___________________________________________
I am an international student ¨ Yes  ¨ No International Student and Scholar Services __________________________________________________
REQUEST TO CHANGE ADDRESS/NAME OR ADD A PREFERRED FIRST NAME
Please change name from ___________________________________________________________________________________________________________________
Last First Middle
to _______________________________________________________________________________________________________________
Last First Middle
Certied copy of an original marriage license or court decree must be attached for name changes. Additional documentation may be requested.
Please update the address(es) listed below:
PR PERMANENT ________________________________________________________________________________________________________________
HOME ADDRESS
________________________________________________________________________________________________________________
Telephone Number ______________________________________________________________________________________________
MA LOCAL ADDRESS ________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
Telephone Number ______________________________________________________________________________________________
BI BILLING ADDRESS ________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
Telephone Number ______________________________________________________________________________________________
HR HUMAN RESOURCES ________________________________________________________________________________________________________________
PAYCHECK/W-2 FORM
ADDRESS _______________________________________________________________________________________________________________
Telephone Number _____________________________________________________________________________________________
RGR-457-0220
CURRENT INFORMATION
UPDATE INFORMATION  ¨ Name  ¨ Address
FOR OFFICE USE ONLY
_____________________________________   ________________________________
HR Initiator Date  REGS Initiator Date
NAME ______________________________________________________________________________________________________________________________________
Preferred First Name to be added
*The university reserves the right to deny a preferred rst name request if inappropriate in nature.
UPDATE INFORMATION  ¨ Add preferred rst name*
The legal last name (surname) will remain unchanged and included with the preferred rst name.
Preferred rst names are limited to alphabetical characters, a hyphen (-) and a space.
Florida Institute of Technology § Oce of the Registrar § 150 West University Boulevard, Melbourne, FL 32901-6975 § 321-674-8115 § Fax 321-674-7827
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REQUEST TO CHANGE ADDRESSNAME OR ADD A PREFERRED (Florida Institute of Technology)

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Completed 29 January 2021

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