Use this form to officially change your name through SIU School of Medicine.
Instructions
OFFICIAL DOCUMENTATION AND VALID IDENTIFICATION MUST BE PRESENTED WITH A COMPLETED REQUEST FORM.
Acceptable forms of ID include state-issued picture ID and one of the following:
- Marriage certificate
- Divorce decree
- Court order
- Birth certificate
You can fill out the form below and submit it to the SIU School of Medicine Registrar
Form Download