Penn State Office of the University Registrar

Name Change Form

Please fill out this online form, print (using "Print Form" button at bottom of page), sign and:
Return to:
Academic Records
112 Shields Building
University Park, PA 16802-1271
Fax 814-863-1929

Name as it currently appears in Penn State's records:
New Name:
Two proofs of identification bearing the revised name requested, one of which contains a photograph, are required:
*All documents must have a valid signature*
(required if receiving federal or state student aid)

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: _____________________________________ Date: ___________________

Registrar's Office Use Only

Proof Verified By: _____________________________________ Date: ___________________

Date Entered in LionPATH: _________________ Entered By: __________________________________

Revised 8/30/16