Name Change Form

← Back to document page

Name currently on record. Last Name First Name. Middle Name or Initial New Name. Last Name First Name. Middle Name or Initial Check here if you wish to have your existing license parchment replaced with one in your NEW name. Enclose your original parchment and a $10 check or money order made payable to the New York State Education Department ...

  York, Department, Education, States, Name, Your, New york state education department