Name Change Request

Office of Enrollment Services

111 University Parkway, Suite 202

Yakima WA 98901

Phone: 509.452.7888 or 509.249.5100

Fax: 509.249.7907

registrar@pnwu.edu
In accordance with the Family Educational Rights and Privacy Act, only the student may request a name change on the official university records.

Complete the form, and submit documentation to registrar@pnwu.edu. You must provide legal documentation of the name change (e.g., certified copy of marriage certificate, divorce decree, or court order) before we can change your name on your official records.
Name*

First NameMiddle NameLast NameSuffix
PNWU ID (no dashes)*
Phone Number*

Area CodePhone Number
Date of Birth*

MonthDayYear
E-mail*
Do you want your PNWU Email to be changed?*

YesNo
Please enter your middle name and suffix (if applicable) below, if you want it to be reflected on your official academic record. This includes transcripts, and diplomas.
New First Name*
New Middle Name
New Last Name*
New Suffix
Signature*

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