Winona State University Change of Name
Warrior Hub Maxwell Hall 209 P.O. Box 5838 Winona, MN 55987 Ph: (507) 457-2800 Fax: (507) 457-5578
Updated: 01/28/2020
Warrior ID or StarID**: _________________________ Year/Term: __________________________
**If you do not know your ID, please provide only the last 4 digits of your SSN
SSN: X X X – X X – _________ AND YOUR DATE OF BIRTH: _______________________
*A copy of your social security card with the updated name must be attached to this form
*International Students – do not complete this form. An updated passport must be brought to the
International Student & Scholar Services Office.
Name as you want it to appear on your permanent record (please print):
______________________________________________________________________________________________________________________________
Last First Middle
Previous Name (please print): __________________________________________________________________
Maiden Name (please print): __________________________________________________________________
Current Address: Current Phone Number:
____________________________________________ ______________________________
____________________________________________
____________________________________________
____________________________________________
Do you have a graduation application on file? ____ Yes ____ No
Signature: ______________________________________________ Date: ________________________
(signature must be handwritten)
