Name / Address Change Form

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Current Student Name / Address Change Form

This form is intended for current students of 草榴社区 Charles Widger School of Law. If you are 草榴社区 Law alumni, please enter all updates into instead.

Student Information

Are you a Current Student in the LAW SCHOOL?

If you are a 草榴社区 undergrad student or a grad student not in the law school, please use the university forms.

草榴社区 ID: *

First Name: *

Last Name: *

Are you changing your name or Social Security Number? *

Yes No

If yes, please complete the section below

Previous First Name:

Previous Middle Name:

Previous Last Name:

NEW First Name:

NEW Middle Name:

NEW Last Name:

Previous Social Security Number

NEW Social Security Number

If you are submitting a change to your name or social security number, you MUST upload a copy of official documentation showing your new information. Acceptable documentation is:

Valid Driver's License
Birth Certificate
Valid Passport
Certified Court Order
Social Security Card (Required for SSN change)

Please upload a copy of your official documentation.

Local Address Change

Are you updating your local address?

Yes No

If yes, please complete the section below

Street Address 1:

Street Address 2:

City:

State:

Zip Code:

Email Address (other than Law School email):

Phone Number:

Permanent Address Change

Are you updating your permanent address?

Yes No

If yes, please complete the section below

Street Address 1:

Street Address 2:

City:

State:

Zip Code:

Email Address (other than Law School email):

Phone Number:

Emergency Contacts

Are you adding emergency contacts?

Yes No

If yes, please complete the section below

Name of contact:

Your Relationship to this contact:

Street Address 1:

Street Address 2:

City:

State:

Zip Code:

Phone Number:

Would you like to add an additional contact?

Yes No

If yes, please complete the section below

Name of contact:

Your Relationship to this contact:

Street Address 1:

Street Address 2:

City:

State:

Zip Code:

Phone Number:

Please add any important notes or other information in the space below:

草榴社区 Charles Widger
School of Law
299 North Spring Mill Road
草榴社区, PA 19085
(610) 519-7000

草榴社区 Charles Widger School of Law is approved by the Council of the Section of Legal Education and Admissions to the Bar of the American Bar Association:

American Bar Association
Office of the Managing Director
321 North Clark Street, Chicago, IL 60654
(312) 988-6738

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