Get Ctc Name Change

DECLARATION OF NAME CHANGE FORM 41-NC You may submit a name change at any time using Online Services for Educators on the Commission s website. There is no additional charge for the name change. If technical problems block you from using the online system to complete the name change you may submit this Declaration of Name Change Form 41-NC by postal mail. Mail to Commission on Teacher Credentialing 1900 Capitol Avenue Sacramento California 95811-4213 Commission Use Only IHE/County/District Use Only Social Security Number Date of Birth mm/dd/yyyy Applicant s Full Legal Name All Former/Maiden Name s Address City County of Employment Issuance Date CCTC Use Only State Home Phone Work Phone Email Address CCTC Use Zip Message Phone Instructions To submit a name change to the Commission and verify your true identity by mail you must send this completed original Declaration of Name Change form 41-NC to the Commission office. This application must include your former name and former signature as well as your new name and new signature. This application must include your former name and former signature as well as your new name and new signature. You must also include a copy of one of the following items as supporting documentation social security card passport marriage certificate court order naturalization papers divorce decree This information may be sent to the Commission by any of these means 1 fax to 916-327-3166 2 scan into an email and send to credentials ctc*ca*gov or 3 send by postal mail to 1900 Capitol Avenue Sacramento CA 95811-4213 Declaration I have changed my name from and hereby request that all records bearing my former name be updated to reflect my new name. FORM 41-NC 8/13 Page 1 of 2 I certify that the foregoing is true and correct under penalty of perjury. City or Place Signature Former Name Signature New Name Important Information Once your records have been reviewed by Commission staff it is possible that your packet may be returned to you for additional fingerprint information* If this happens you will be required to submit a copy of a LiveScan receipt 41-LS verifying you have had your fingerprints taken and have paid the fingerprint processing fees to the LiveScan operator. Out-of-state residents must submit two fingerprint cards FD-258 in lieu of a LiveScan receipt. When submitting fingerprint cards a fingerprint processing fee must accompany the returned application* The Commission no longer prints and mails credentials certificates and permits. All credentials certificates and permits are available through an online view and print process on the Commission s website at www. This application must include your former name and former signature as well as your new name and new signature. You must also include a copy of one of the following items as supporting documentation social security card passport marriage certificate court order naturalization papers divorce decree This information may be sent to the Commission by any of these means 1 fax to 916-327-3166 2 scan into an email and send to credentials ctc*ca*gov or 3 send by postal mail to 1900 Capitol Avenue Sacramento CA 95811-4213 Declaration I have changed my name from and hereby request that all records bearing my former name be updated to reflect my new name.