NAME AND ID NUMBER CHANGE FORM
Completed and approved form should be taken to the One Stop Enrollment Center for processing. Student must
present valid photo ID at the One Stop Enrollment Center at time of processing. Effective date of this request is the date
it is processed at the One Stop Enrollment Center. Faxed forms not accepted.
Current Name on
Record (First):
Middle:
If this is a name change request: New Legal Name:
myUTSA ID:
Last:
Last
First
Middle
Yes, I would like my new legal name reflected on my diploma.
Year:
My Anticipated Graduation Date: Month:
2013
REQUIRED VERIFICATION
INTERNATIONAL STUDENTS (graduate and undergraduate): Students holding non-immigrant visas must report to the Office of
International Programs, located in the Main Building 1.210, to update their name.
International Programs Verification:
(print)
(signature)
Date:
NOTE: A photo ID showing your new legal name such as a valid, PERMANENT (not temporary) driver’s
license, military ID, or current Passport AND a legally certified marriage certificate, divorce decree, or
name change document, reflecting the new legal name, must be submitted with this form in person.
COPIES WILL BE MADE OF YOUR OFFICIAL DOCUMENTATION UPON PRESENTATION AT
ENROLLMENT SERVICES AT EITHER THE MAIN CAMPUS OR DOWNTOWN CAMPUS.
If this is a Social Security Number change request:
New Social Security Number
Previous Social Security Number*
A COPY OF THE NEW SOCIAL SECURITY CARD MUST ACCOMPANY THIS FORM.
*Disclosure of your social security number (SSN) is requested from you in order for The University of Texas at San Antonio to access your
student records. No statute or other authority requires that you disclose your SSN for that purpose. Failure to provide your SSN, however,
may result in a delay in accessing your student record. Further disclosure of your SSN is governed by the Public Information Act (Chapter
552 of the Texas Government Code) and other applicable law.
Are you a current or former employee of UTSA?
Yes
No
If yes, you must also go to Human Resources to change your name.
With a few exceptions, you are entitled on your request to be informed about the information U.T. San Antonio collects about you. Under Sections 552.021 and
552.023 of the Texas Government Code, you are entitled to receive and review this information. Under Section 559.004 of the Texas Government Code, you are
entitled to have U.T. San Antonio correct information about you that is held by us and that is incorrect, in accordance with the procedures set forth in the
University of Texas System Business Procedures Memorandum 32.
Date:
Signature:
Telephone Number:
Preferred Email Address:
Address, email, phone number, and emergency contact changes should be made via ASAP at http://utsa.edu
8 This form is available at utsa.edu/registrar/forms.html
(Rev.022213)