Yes
No
CHANGE OF NAME FORM
______________________________
_____________________
Former Name
ID Number
_____________________________
______________________
Name Changed To
(print)
Effective Date of Change
_____________________________
Telephone Number
Are you currently enrolled?
Yes
No
Are you currently employed by the
university?
Yes
No
(If Yes, you must take your new social
security card to Human
Resources for processing of payroll information)
___________________________________
_____________________
Signature
Today’s
Date
PLEASE PROVIDE PROOF OF YOUR NAME CHANGE…EXAMPLES INCLUDE A COPY OF LEGAL DOCUMENT , YOUR NEW SOCIAL SECURITY CARD, OR DRIVERS LICENSE INDICATING YOUR LEGAL NAME.
Make sure to change your Tower One Card in 221 Cartwright
Center
Check here
if you wish to have your campus e-mail address reflect
this change
To officially change your name
on UW-La Crosse records,
this form must be completed and returned along with
documentation to:
Records & Registration
UW-La Crosse
1725 State Street
La Crosse, WI 54601