Name Change Form

Instructions

  1.  Please include with this submission a copy of your legal documentation indicating name change.     Examples of legal documentation are marriage license, divorce decree, driver's license, etc.

  2.  Please do not upload your social security number.  

  3.  If you have applied for graduation and would like your new name on your diploma, please let us know by emailing registrar@valdosta.edu.  Completing this form will not automatically change your name on your degree or in the commencement program.  

  • First Name
    Middle Name
    Last Name

  • File attachment size limit is 2 MB.
  • Legal documents include but are not limited to driver's license, marriage license, divorce degree, etc.

  • Yes
    No
  • False swearing statement: I understand that any material false statement made knowingly and willingly by me on this form, or any documents attached hereto may, in accordance with O.C.G.A. 16-10-71, which provides that upon conviction, a person who knowingly commits the offence of false swearing shall be punished by a ne of not more than $1,000 or by imprisonment for not less than one nor more than five years, or both, subject me to prosecution in a court of law. Additionally, I further understand that any such false statement may subject me to immediate dismissal from the institution.
  • Security Captcha: *
  • 229.333.5727
  • 229.333.5475
  • Campus Address
    University Center
    Entrance No. 5
    1205 N. Patterson St.
    registrar@valdosta.edu
  • Mailing Address
    1500 N. Patterson St.
    Valdosta, GA 31698