REG - Name Change

REG - Name Change

Valparaiso University | Office of the Registrar
1700 Chapel Drive | Kretzmann Hall | Valparaiso, IN 46383
Phone: 219.464.5212 | Email: registrar@valpo.edu
Hours: Monday - Friday, 8:00 AM - 5:00 PM Central Time
For assistance in selecting the appropriate form, please visit guide to Selecting a Form and the Academic Calendar.

  • Date Date / /
    Pick a date.
  • Minimum of 7 characters required.   Currently Entered: 0 characters.
  • Date of Birth Date of Birth * / /
    Pick a date.
  • Phone Phone - -
  • Former Name Former Name *
  • Former Marital Status *
    Former Marital Status
  • Current Name Current Name *
  • Current Marital Status *
    Current Marital Status
  • Have you applied for graduation at Valpo? *
    Have you applied for graduation at Valpo?
  • Required Documentation:

    A copy of your current driver's license, along with court documentation (marriage certificate, etc.), both reflecting your new name. Students having an F1 or F2 visa status must include a copy of their passport or visa.

  • Please be advised that students may be required to present additional documentation, should the name change constitute specific documentation required by the state in which the student resides.

  • By signing electronically below, I confirm that I am able to access information in an electronic form and I also agree that the institution does not need to provide me with an additional paper (non-electronic) copy of the document unless specifically requested.

  • Draw or Type
    I understand this is a legal representation of my signature. Clear