Orange County Community College 
Middletown, NY 

humanresources 

DATE:
TO:
FROM:
RE: NAME CHANGE


Please update your records regarding the name change 
listed below: 
FORMER NAME 
(please print) 
NEW NAME 
(please print) 
SIGNATURE 

SOCIAL SECURITY #


Thank you. 

FOR HUMAN RESOURCE USE ONLY 
c: Switchboard OCCC 
Payroll 
Pres. Office 
Academic Affairs 
Telephone Directory 
File 
forms3:namechan