DRAKE UNIVERSITY
COLLEGE OF PHARMACY AND HEALTH SCIENCES
NOTIFICATION OF CHANGE OF NAME


Please complete all fields:
Former Name:
  First Middle Last 
New Name:
  First Middle Last 
Effective Date: 
Local Address:
City, State, ZIP:
 , 
Permanent Address:
City, State, ZIP:
 , 
Major:
   Health Sciences      Pharmaceutical Sciences    Pre-Pharmacy/Pharmacy   
Classification:  
   FR    SO   JR    SR    P1     P2    P3    P4
Phone Number:
Email:
Advisor:

Please ensure the following non-Drake offices have been notified of your name change!

    Social Security Administration    [Department of Education matches records -- name, birth date, SSN -- with Social Security Administration]

    Iowa Board of Pharmacy -- Pharmacy Students ONLY     [Iowa Board of Pharmacy matches internship hour records with Board applications by name]

Completion and submission of this form will ensure notification of your name change to the College of Pharmacy and Health Sciences.  The College of Pharmacy and Health Sciences will subsequently notify the Office of Student Records as well as any and all applicable offices at Drake University.


You will receive a confirmation email verifying receipt of this form by the Office of Academic and Student Affairs in the College of Pharmacy and Health Sciences.

8/2/08

created by: rjc