CHANGE OF NAME REQUEST: 

The University of Tennessee (Knoxville)
Print a Copy and Complete.


Student ID Number:  
 

  _
 

 _
 



 
 

SOURCE

S

R

1


Change from:_________________________________________________________________
                        Last Name                              First                                    Middle
To :         (Do not write outside of the squares!)
  
  
  
  
  
  
 
   
  
  
 
  		 
  
  
   
  
  
  
 
  		  
  
  
 
  		  
  
Last Name First Middle   2

Check appropriate box below. Attach a readable photocopy of the required document listed and mail or fax to this office.  Appropriate documentation must accompany request.

Reason for Change:

o Marriage      
o Divorce         
o Legal Name Change
o Correction to name   


Document Required for Change To Be Made:

Marriage Certificate or Driver's License with the new name
Divorce Decree or Driver's License with the new name
Court Order or Driver's License with the new name
None--we will check the records


Are You Currently Enrolled?    (  ) Yes     (  ) No

If not, when were you last enrolled? ___________________
                                                            term of last enrollment


Signature: _______________________________________________  Date: __________________

 

Local Address: ___________________________________________________________________
                            Street/P.O. Box      Apt.              City                  State             Zip Code


MAIL OR FAX:
The University of Tennessee
Office of the University Registrar
209 Student Services Building
Knoxville, TN  37996-0200
FAX: (865) 974-2606