Name Change Form

Directions: Please complete and sign this form online. While it is our preference that this form be submitted through the online form, we also want to present the option of submitting a hard copy. If you would prefer to submit a hard copy, then please print, complete and return to the Office of the Registrar.

Would you like to use your UNCP ID or Last 4 digits of SSN?
Current Student Name
New Student Name
Contact Information
Have you applied for graduation?

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
  • Passport
  • Court Documents
  • F, J, IR1, CR1 Visa Card/Documentation
One file only.
24 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, ppt, pptx, xls, xlsx.
Signature
Sign above
08-03-2020
FOR OFFICE USE ONLY

Downloads

Name Change Form (PDF) - (Revised: 03-13-2017)
Name Change Form (DOCX) - (Revised: 03-13-2017)