Printing and Delivery – In order to petition for a change of name, birth date, or student ID number, please download and complete the PDF form.
Copies of TWO pieces of supporting documentation are required: 1) new SS card, marriage certificate, or court decree of name change, AND 2) new driver’s license or state ID.
Mail or bring the completed form to the address below.
Medical Student Education – Student Affairs
IU School of Medicine
635 Barnhill Drive, MS 164
Indianapolis, Indiana 46202
*If you wish to have the name on your e-mail address changed, you must contact the UITS Support Center. You need to take proof of your name change and put in a request with them.