Temple University: Office of Student Academic Records

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NAME CHANGE REQUEST FORM
Except in cases of typographical errors a court order or other legal document must accompany this form.

 
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TUID or SOCIAL SECURITY NUMBER _________________

CURRENT NAME	Print your current name
 
______________________________, _______________________ __
Last Name                       First Name              MI     


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FORMER NAME	Print your former name as it currently appears on your records

______________________________, _______________________ __
Last Name                       First Name              MI   


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REASON FOR CHANGE (Official documentation must be attached.)
	____Married 
	____Resumption of Maiden Name ____Legal Name Change
	____Error (explain)______________________________________________
	____Other _______________________________________________________

    
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STATUS 
	Last semester attended _________
	School/College__________________
	Degree & date (if applicable)__________


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CERTIFICATION 

I, _____________________________________ hereby certify that I was formerly
known as _______________________________, and under that former name Temple 
University has maintained my scholastic records. Hereafter, please maintain 
my records under my current name.


YOUR SIGNATURE (required)_____________________________________ Date:_______
     

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IMPORTANT
If you have an application for admission pending you must notify the appropriate admissions office of your new name.

Mail Request To:
Temple University
Office of Academic Records
1801 N. Broad St.
Philadelphia, PA 19122

Fax Request To:

(215)204-6626

If you have questions or suggestions, please send us e-mail at arecords@temple.edu.

Temple University requests your Social Security Number because federal, state and local law requires the University to report the name, address, and SSN for certain purposes. Temple University will not disclose your SSN without consent unless it is required to do so by law, or as permitted by the University's Social Security Number Usage Policy (http://policies.temple.edu/getdoc.asp?policy_no=04.75.11).