Registrar: Address/Name Change Form

Hidden Form Name
Office of the University Registrar
Division of Academic Affairs

1009 Rollins Hall ● Norfolk, VA 23529-0052 ● Telephone: (757) 683-4425 ● Fax: (757) 683-5357
Address/Name Change Form

Use this form to notify the Registrar’s Office of name and/or address changes.
(University employees should contact Human Resources to complete name and address changes.)
Student’s Name Student’s Name * First Middle Last
Email Address *
University ID Number (or SSN): *
Must be between 8 and 11 characters. Currently Entered: 0 characters.
Date of Birth Date of Birth * / MM / DD YYYY
Currently Enrolled? *

Currently Enrolled? Yes No
Name Change

(A copy of your new Social Security Card is REQUIRED to process a name change. See note below regarding e-mail accounts)
Previous Name Previous Name Title First Middle Last Suffix
Please put previous full legal name
New Name New Name Title First Middle Last Suffix
Please put current full legal name
Existing Graduation Application?

Existing Graduation Application? I have recently applied for graduation and I would like my name change to be reflected on my diploma.
Address Change

Note: You can update your own address records through the Old Dominion University secure website (LEO Online) at
www.leoonline.odu.edu. Log in to the secure web site, click on “Personal Information” then “Update Address.”
New Permanent Address New Permanent Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
(where diplomas, bills, refunds and other important University correspondence will be mailed)
Phone Phone - ### - ### ####
New Current Address (IF DIFFERENT FROM PERMANENT ADDRESS) New Current Address (IF DIFFERENT FROM PERMANENT ADDRESS)
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
(this address may be your residence hall or other temporary residence)
Phone Phone - ### - ### ####
New Emergency Address (IF DIFFERENT FROM PERMANENT ADDRESS) New Emergency Address (IF DIFFERENT FROM PERMANENT ADDRESS)
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Phone - ### - ### ####
Acknowledgment *

Acknowledgment If you are enrolled in an Old Dominion University program that leads to a professional licensure, and reside in (or intend to seek licensure in), a state other than Virginia, we strongly recommend that you contact the relevant licensing agency in your state or the state where you intend to work upon completion of your degree, to obtain the most recent licensure requirements. Old Dominion University makes every effort to ensure up-to-date information, however licensing regulations often change without notice.
NOTE: E-mail accounts are not automatically updated with your new name. Students may request that their name be changed in the e-mail system, but new e-mail addresses should be requested only at the end of the term. For information on changing e-mail names and e-mail addresses, contact ITS by email at itshelp@odu.edu or by phone at (757) 683-3192. Students whose name changes in the middle of the term should notify their instructor(s), providing their new name and their current ODU student e-mail address.
Draw your signature into the box below. *

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Today's Date Today's Date / MM / DD YYYY
Upload a File (Social Security Card required if requesting name change)

Attach Files
Please allow 3-5 business days for processing.
-- BDMS -- Index to: Address/Name/SSN Change Forms

Registrar: Address/Name Change Form

Name Change

Address Change

Please allow 3-5 business days for processing.