Name Change Form

Name Change Form
Student ID
Previous Legal Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Phone Number
Format: (000) 000-0000.
Email Address
example@example.com
Section A: Legal Name Change Instructions

Requested Change
New Legal Name

First NameLast Name
Required Documentation for Legal Name Change

Documentation must be included to process the request. Please upload one of the following documents with this request.
- Copy of photo identification reflecting your previous name.
- Copy of valid government-issued ID reflecting your new name (driver's license, state ID, passport,
  etc.).
- Legal, court-filed document supporting the name change (marriage license, divorce decree, or court
  order).
File Upload

Cancelof
Certification

I hereby request that my legal name be updated in all offficial California Indian Nations College records. I certify that the documents provided are true and valid.
Student Signature

Clear
Date

MonthDayYear
Date
Section B: Preferred Name Request
Preferred Name
Certification

I hereby request that my records at California Indian Nations College be updated as indicated above. I request my preferred name be used on unofficial college records when permitted.
Student Signature

Clear
Date

MonthDayYear
Date
CINCollege.org / 760.834.0593 / 75080 Frank Sinatra Drive, Suite 222, Palm Desert, CA 92211
Should be Empty: