Name Change Request Form - Indian Hills Community College

Office of the College Registrar
This form can be filled out with Adobe Acrobat and then printed for signature.
(Must be accompanied by acceptable legal documentation as defined on page 2)
Name Change Request Form
Return Form To:
Registrar’s Office
623 Indian Hills Dr.
Ottumwa, IA 52501
Please read all Guideline instruction on page 2 before completing and submitting this form:
IHCC ID: _____________________________ Social Security Number: ______________________________
Current Name:
Last: ________________________ First: ____________________ Middle______________ Suffix _______
New Name:
Last: ________________________ First: ____________________ Middle______________ Suffix _______
Student Status:
Are you a currently enrolled student?
Yes
No
If no, dates of attendance: ____________________________
Reason for Change: (Check one)
Correct Spelling
Other
Marriage
Divorce
Court Order
Explain: ___________________________________________________________________
Students who are receiving any form of federal student aid are required to change their name with the Social
Security Administration before changing their name with Indian Hills Community College.
Academic records are maintained in perpetuity and are often referred to long after students have stopped
attending. It is the policy of Indian Hills Community College that only legal names be used on students’
academic records. Nicknames, assumed names, etc. will not be used.
My signature authorizes Indian Hills Community College to use this name for all future transactions.
Student Signature: __________________________________________________ Date: ________________
-----------------------------------------------------------Registrar’s Office Use Only------------------------------------------------------------------Proof Verified By: _________________________________________-____ Date: _______________________
Date Entered into Datatel: _____________________ Entered By: _____________________________
Guidelines for Changing the Name on Official Indian Hills Records
The Registrar’s Office is responsible for maintaining a student's official legal name for all academic
records maintained by Indian Hills Community College. Please read the following guidelines carefully
before requesting a change of name. These guidelines will assist you in changing your legal name with
Indian Hills. Legal documentation must accompany the completed Name Change Request form in
order to alter your name as it appears on your Indian Hills records. You must present the original legal
document, which will be copied and maintained in your Indian Hills student file. If you are requesting a
name change via mail, you must submit a certified copy of the legal document(s) that bears a notary
seal. Acceptable legal documents for name changes are determined by the reason for the change as
shown below. A driver's license, social security card, or marriage certificate issued by a
church, are not acceptable as legal documentation for a change of name, except when
correcting a minor spelling error such as a transposition of letters.
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MARRIAGE: Original marriage license bearing the filing stamp from the county or parish in which
the license was issued. Church-issued marriage certificates are not acceptable documentation.
DIVORCE: Original divorce decree that includes a specific decree granting restoration of the
maiden name. The decree must be signed by the presiding judge and bear the county filing
stamp. (If submitting a copy, you need only include the first page of the decree, the page
containing the name restoration order, and the page bearing the judge's signature.)
COURT ORDER: Original court order signed by the presiding judge and bearing the county filing
stamp.
CITIZENSHIP BY NATURALIZATION: Original Certificate of Naturalization.
CORRECT AN ERROR ON THE ADMISSION APPLICATION or STUDENT RECORD: Birth
certificate or current, valid U.S. passport.
IMPORTANT NOTE FOR INTERNATIONAL STUDENTS: International students' names must
appear on your college records exactly as they appear on the passport issued by your
home country. The U.S. entry visa may not be used as documentation for a name change.
The legal name as maintained in the Indian Hills student records system will be the name that
appears on your Indian Hills transcript. Changes permitted to your name are as follows:
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FIRST NAME: You may not drop, alter, or change your first name without legal documentation
such as a birth certificate, court order, Certificate of Naturalization, or passport. International
students may not alter any portion of their name from the way it appears on their passport.
MIDDLE NAME: You may change your given middle name to a middle initial (i.e. change "Sue"
to "S.") without legal documentation. A birth certificate, passport, or Certificate of Naturalization
is needed to expand the middle name from an initial or to remove the middle name completely.
Name changes permitted based on a marriage license include replacement of the given middle
name with the maiden name or inclusion of the maiden name with the given middle name.
International students may not alter any portion of their name from the way it appears on their
passport.
LAST NAME (SURNAME, FAMILY NAME): Your last name may be changed only on the basis of
a marriage license, divorce decree granting restoration of the maiden name, Certificate of
Naturalization, or court order. When changing your name based on marriage, you may replace
your maiden name with your married name, or use both names. A combined surname will be
hyphenated. International students may not alter any portion of their name from the way it
appears on their passport.
If requesting your change of name in person, the original documents must be presented to the
Registrar’s Office where a copy will be made for your student file. Only a certified copy of an
original legal document will be accepted by mail. No change of name will be processed on the basis
of a document sent by facsimile (fax).