Name and Address Change Policy

All name and address change requests for non-licensed applicants must be submitted to the Board office. Requests for address changes must include your new address and telephone number, your previous address, the last 4 digits of your social security number, and your e-mail address (optional). You may fax address changes to (717) 231-3351. Requests for name changes must include your former name, your new name, your current address and daytime telephone number, the last 4 digits of your social security number, the reason(s) for the name change, and official documentation of the name change (i.e., copy of marriage license, copy of legal name change, copy of divorce decree, etc.).

Address Name Change FormView Form