UREG
University of Virginia
Applicant Name Change Form
Name Changes for Applicants who are Former Students.
Date
School or
SCPS Center to
which you are
applying
Previous Last Name:
Previous First and
Middle:
I.D. Number:
New Last Name:
(if different)
New First and Middle:
(if different)
Reason for Change:
A copy of a court order, driver's license, marriage certificate, passport, social security card, or some other official document showing the
new name and /or number must accompany this form.
Send form along with accompanying documentation to your school's admission office.
Signature: ______________________________________________________
For office use only:
School Representative initials: ____________
/
Approved Official Documentation
(put X in box for approval)