University Registrar : Name Change Affidavit

IMPORTANT: This form cannot be submitted electronically. Please type in the required information, print, sign and mail to the appropriate address.

Remember to include photocopies of the following forms of ID:

Government-issued photo ID
Another form of ID
Proof of use of the old name (credit card,CUID,marriage certificate, bank statement, etc)

Morningside Campus

Office of the Registrar
Columbia University
210 Kent Hall, MC 9202
1140 Amsterdam Avenue
New York, NY 10027

Medical Center Campus

Student Administrative Services
Columbia University
630 W. 168th Street
Unit 45, Black Building
1st fl., Room 141
New York, NY 10032

Columbia University in the City of New York

Name Change Affidavit

Print Form

Identification and Date

CUID:

Date:

The undersigned, being duly sworn, deposes that prior to the date indicated below, he or she was enrolled at Columbia University:

Previous Name

Last:
First:	Middle:

That on or about (date) Date of Name Change: , his or her name was changed to:

New Name

Last:
First:	Middle:

and that this is the name which he or she is now and will hereafter be known.

Columbia Attendance

School	Dates	Degree
School 1	School 1 Dates	School 1 Degree
School 2	School 2 Dates	School 2 Degree 2 Degree
School 3	School 3 Dates	School 3 Degree

Student's Signature

County

State

Subscribed and sworn before me on this date

Notary's Signature

Notary Stamp

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Name Change Affidavit

Morningside Campus

Medical Center Campus

Columbia University in the City of New York

Name Change Affidavit