REG - Name Change Authorization Form

Name Change Authorization Form

Registrar's Office University of Louisville Louisville, KY 40292 Phone: (502)852-6522 Fax: (502)852-7088

Student ID *

Former Name *

New Name *

Documentation Required (optional)

Copy of current photo ID (unexpired)

Copy of Signed Social Security Card with new name

Student Signature

Please right-click on the screen, print form, sign and mail/fax to the address/number above with required documentation.