Statement of Responsibility:
I assure responsibility for the consequences or problems that may occur as a result of this change of my name. There is no intent on my part to defraud the University of North Carolina at Pembroke.
Please note: Employment verification requires a social security card to ensure that the name and social security number on record match the name and number on the social security card.
This form requires that one (1) of the following documents is uploaded with your submission:
- Driver's License
- Social Security Card
- Divorce Decree
- Court Documents
- F, J, IR1, CR1 Visa Card/Documentation