• Explore
• Admission
• Academics
• Student Life
• Spiritual Life
• Alumni
• Athletics

Loras Home

Request A Transcript

Codes for New General Education Curriculum

Address Change Form

Name Change Form

Contact Us

Lead America Credits

NOTIFICATION OF NAME CHANGE FORM

Return the signed form to the Registrar's Office by mail, Loras College, Mail #1, Dubuque, IA  52004-0178
or by facsimile (fax) (563) 588-4962

I hereby request that my full name be changed on all permanent student records at Loras College.

PLEASE PRINT!

Former Name:

Prefix: (Mr. Mrs. Ms. Dr. etc.)

First name:

Full middle name:

Last name:

Suffix: (Jr., III, Ph.D., M.D., etc.)

New Name:

Prefix: (Mr. Mrs. Ms. Dr. etc.)

First name:

Full middle name:

Last name:

Suffix: (Jr., III, Ph.D., M.D., etc.)

ADDITIONAL INFORMATION

Maiden name:

Social Security Number:

Birthdate: (Month, day, year)

Mailing name: (exactly as you wish it to appear)

Dates you attended Loras College:

My current permanent address is:

Street:

City: State:Zip:

Signature:Date: