Registrar's Office - Oral Roberts University

Address / Name Change Request Form

ID#:			Date:
Name:

LOCAL ADDRESS:

Address

City State Zip

Country Phone

NEXT OF KIN:

Name Relation

Address

City State Zip

Country Phone

PERMANENT ADDRESS:

Address

City State Zip

Country Phone

DIPLOMA ADDRESS: (if applicable)

Address

City State Zip

Country Phone

MARITAL STATUS:

Married

Divorced

Single

Widowed

MAIDEN / FORMER NAME:
(Please type in your name as it appears in our records now)

NAME CHANGE:
(Please type IN FULL your new name)

* PLEASE NOTE: LEGAL DOCUMENTATION IS NEEDED FOR A NAME CHANGE. (EX: Photocopy of a marriage certificate is accepted)

Once you click submit, you will be taken to the form that you have just created. Please print and sign the form then fax, mail, or deliver it to the Registrar's Office.