Students who are 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 of the information is entered correctly, please print (using "Print Form" button at bottom), sign and submit the form to the address at the top along with the two proofs of identification.
My signature authorizes the Pennsylvania State University to use this name for all future transactions.
Student Signature: _____________________________________
Registrar's Office Use Only
Proof Verified By: _____________________________________
Date Entered in LionPATH: _________________
Entered By: __________________________________