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NAME CHANGE REQUEST FORM:

1. Student Name: ___________________________________

2. Student ID: _______________________________________

Change From:

Old Student Name: _________________________________

3. Address: ________________________________________


4. Change Name To:
___________________________________________________

5. Address: _________________________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________

6. PLEASE READ CAREFULLY: I understand that the TDLI cannot assume responsibility and is not liable for any adverse consequences to any individual, including and detriment caused by the mistakes in recording information, which result from my action to change my name as it appears on my university records at the time of registration and transcription. I also understand that this change of name may cause further complications in ordering transcripts that were previously sent, or ordered, under my former name. Further I understand that the TDLI cannot withhold the facts relating to the information given on this name change application.

6. Signature of Student or Graduate:


END OF NAME CHANGE REQUEST FORM.
 

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