CORONAVIRUS UPDATES: Keep up with the latest updates from Penn State about the global coronavirus outbreak.

 

Name Change Form

Please print, sign, and return the completed form to:

Academic Records
112 Shields Building
University Park, PA 16802-1271

Fax: 814-863-1929

Please print, sign, and return the completed form to:
Academic Records
112 Shields Building
University Park, PA 16802-1271
Fax: 814-863-1929

PSU ID or SSN

9-digit Penn State ID number
Please enter your PSU ID.
*Only enter your SSN if you do not provide your PSU ID number.

Name as it Currently Appears in Penn State's Records

Please enter your last name.
Please enter your first name.

New Name

Please enter your last name.
Please enter your first name.

Attendance and Contact Information

Dates in which you attended Penn State
Please enter your dates of attendance.
Please include area code
Please enter your phone number.

Proof of Identification

Copies of two proofs of identification bearing the revised name requested, one of which contains a photograph, are required. All documents must have a valid signature.

Note: Please do not send original documents. The form should be accompanied by copies of your two proofs of identification that meet the criteria described above.

*Social Security Card is required if receiving federal or state student aid

Students receiving any form of federal or state student aid are required to change their name with the Social Security Administration before changing their name with Penn State.

Please review your entries on this form. If all information is entered correctly, please print, sign, and submit form to the address at the top along with the copies of two proofs of identification.

Student Signature

My signature authorizes The Pennsylvania State University to use this name for all future transactions.

Student Signature: _________________________________________________

Date: ____________________________

Student Signature: _______________________________________ Date: __________________________

Registrar's Office Use Only

Proof Verified by: ______________________________________________

Date: ____________________________

Date Entered into LionPATH: ____________________________

Entered by: ___________________________________________________

Last Revised: 12/16/20