Name Change Request Form

Palmer College of Chiropractic maintains your records under your full legal name. The Registrar’s Office is responsible for maintaining an individual’s official legal name for Palmer College of Chiropractic. The following guidelines will assist you in changing your legal name on Palmer College records after you have legally changed your name. Requests for current students will update the student’s record, to include the academic transcript. Requests for alumni will update the alumni record only; transcripts continue to reflect the legal name at the time of graduation.

Strong evidence is required to establish a link between you and the record being changed.

Submit a Request for Name Change Form to request your name be changed on College records. This form is also available in the Registrar’s Office.

Along with your request, the following supporting documentation is required to change your name:

  • Name Currently on Palmer College records
    • Documentation showing your name as it currently appears on your Palmer College records
      • Picture ID preferred
      • Birth certificate or social security card acceptable

AND
One of the following that pertains to your personal circumstance:

  • Name Change by Marriage
    • Original marriage license bearing the filing stamp from the county or parish in which the license was issued. Church-issued marriage certificates are not acceptable documentation for a name change.
  • Name Change by Dissolution of Marriage
    • Original divorce decree granting restoration of maiden name. The decree must be signed by the presiding judge and bear the county filing stamp. (If submitting a copy, you need only include the first page of the decree, the page containing the name restoration order, and the page bearing the judge’s signature.)
  • Name Change by Court Order
    • Original court order signed by the presiding judge and bearing the county filing stamp.
  • Name Change by Naturalization
    • Original Certificate of Naturalization.
  • Name Change by Usage Method
    • Documentation that you are using your new name to transact business with both state and federal agencies (both are required)
      • Valid state issued driver license with new name, or valid state issued ID card with new name; and
      • Social security card with new name; and
      • Documentation that links your current and new name.

Submit your completed Request for Name Change Form along with all required supporting documentation to the Registrar’s Office in person, by mail or by fax.

An exception to this policy is the women’s right to retain her maiden name. In cases where our records indicate a maiden name, the change may be made without documentation. However, when no record of a maiden name exists, a copy of a divorce decree or marriage license upon which the maiden name is noted must accompany the request.

For international students, the name maintained on the educational records will be the same as the one that appears on their passport and U.S. Immigration documentation, including the Form I-20, Certificate of Eligibility for Non-Immigrant.

Some professional licensing and certification agencies require that the name on an individual’s diploma be the same as the one on the professional license or certificate. Duplicate or replacement requests for Palmer College must be made online, by submitting a Duplicate Diploma Request. If requesting a new diploma upon submitting a name change, the graduate should go through the appropriate steps to make an official name change with the Registrar’s Office as well as submit a Duplicate Diploma Request.

Note that College policy prohibits name changes to student records (transcript) after graduation.

Palmer College of Chiropractic
Registrar’s Office
1000 Brady Street
Davenport, IA 52803

Name Change Form or
Fax: (563) 884-5864

Palmer College of Chiropractic
Registrar’s Office
90 E. Tasman Drive
San Jose, CA 95134

Name Change Form or
Fax: (408) 944-6196

Palmer College of Chiropractic
Registrar’s Office
4777 City Center Pkwy.
Port Orange, FL 32129

Name Change Form or
Fax: (386) 763-2635

Contact Us

Main campus

Davenport campus
Registrar
1000 Brady St.
Davenport, IA 52803-5214
(563) 884-5654
registrar.ia@palmer.edu

Branch campuses

Florida campus
Registrar
4777 City Center Parkway
Port Orange, FL 32129-4153
(386) 763-2785
registrar.fl@palmer.edu

West campus
Registrar
90 East Tasman Dr.
San Jose, CA 95134-1617
(408) 944-6065
registrar.ca@palmer.edu

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