╨╧рб▒с>■  %'■   $                                                                                                                                                                                                                                                                                                                                                                                                                                                ье┴Й@ Ё┐\ jbjbqФqФ "ЎЎ\      lььььььь (с╢HHHHHHHHЮаааааа,Ч ╖К╠ьHHHHH╠tььHHHtttH ьHьHЮtььььHЮt*tЮььЮ< 9Wx╛R"ЮЮссЮAtAЮt├хChange of Name Form To officially change your name, please print and complete the following form. After completing all fields, sign and date it, then mail or fax (no cover sheet necessary) the form to the NSU Office of Records and Registration. If you are currently enrolled, your new name will not be changed on university records until the end of the current school session. Therefore, please continue to use the name under which you registered throughout this current school session. ╣√╢│APP Office of Records and Registration P.O. Box 2059 Thibodaux, LA 70310 Fax: (985) 449-7060 Phone: (985) 448-4153 Please print or type your name as it currently appears on University records: ________________________________________________________________________ Last First Middle/Maiden _____________________________ ____________________ Social Security number Date of Birth I request that the name on my records be changed to the following: ________________________________________________________________________ Last First Middle/Maiden Mailing address: __________________________________________________________ Number and Street __________________________________________________________ City State Zip Code Reason for name change: ( *Married (date) ___________________________________ ( *Divorced (date) __________________________________ ( *Other (explain) __________________________________ *A Copy of official documents must be presented in order for a name change to become effective. Examples include a marriage license, divorce decree, birth certificate, or passport. Note that a driverТs license and Social Security card are not acceptable. New Signature: _________________________________ Date: _____________ ъw┼  % ) 6 { С Я м п Є ? C M R V c ╛ ╫ % ) - 2 5 = X Y \ Ъ Ы Ю ▌ ▐ с   \ ¤¤·····¤·······ї¤ї¤ї¤¤ j Ё5БCJ5Б*ъы(6JK_uvw┼╞╟ 7 8 9 s н о п Є є Ї = ¤√∙√ЇЇЇЇЇЇЇ√√√√√√√√√√√√√√√√√$a$ъы(6JK_uvw┼╞╟ 7 8 9 s н о п Є є Ї = d e f ▓ ╫ ╪  > ? П Р ╥ ╙     \ ¤√√.= d e f ▓ ╫ ╪  > ? П Р ╥ ╙     \ ¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤√¤ 1Рh░╨/ ░р=!░"░#Р░$Р░%░ i(@ё ( NormalCJmH <A@Є б< Default Paragraph Font(>@Є( Title$a$CJ*B@* Body Text5Б\       аzЩ\\ = \  \ ^?UXП^:  NSU 'C:\My Documents\Change of Name Form.docNSU -C:\My Documents\Forms\Change of Name Form.docNSU -C:\My Documents\Forms\Change of Name Form.docNicholls State UniversitydMacintosh HD:Library:Apache2:htdocs:websites:www.nicholls.edu:www:html:records:forms:name_change.doc @АH^|FH\P @GРTimes New Roman5РАSymbol3Р Arial"ёИЁ╨hv*ФFv*ФFоZВf !Ё░┤┤ББ20s2ГQЁ  Change of Name FormNSU Nicholls State University■  рЕЯЄ∙OhлС+'│┘0ЬШа╝╚╪фЁ $0 L X d p|ДМФ'Change of Name FormhanNSU e oSU SU Normalo╣√╢│APP.2chMicrosoft Word 10.1@@lz%╢Ё├@tхLя9┼@tхLя9┼■  ╒═╒Ь.УЧ+,∙о0№ hp|ДМФ Ьдм┤ ╝ ▄'ge s Change of Name Form Title ■    ■   ■    !"#■   ¤   &■   ■   ■                                                                                                                                                                                                                                                                                                                                                               Root Entry         └FА:DБ┼9┼(А1Table         WordDocument        "SummaryInformation(    DocumentSummaryInformation8            CompObj            X                        ■                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           ■      └FMicrosoft Word Document■   NB6WWord.Document.8