PTCB Name Change Form

Please complete the form below to request an update to your name. 
Your PTCB Account ID number is the 6 or 8 digit number found on your PTCB Account, under the Profile Summary section. Your PTCB Account ID Number is not your PTCB Certification Number. 

If your name does not include a middle name, please leave the middle name fields blank. 

Acceptable documentation includes marriage certificates, divorce decrees, court documentation, immigration documentation, and government issued identification. 

Name change requests typically take up to 10 business days to be processed. Please enter your email address associated with your online PTCB Account. Entering an email address not associated with your PTCB Account may prevent your name change request from being received.
 
PTCB Account ID*
 
 
Email -- Please use the email associated with your online PTCB account*
 
 
Request Type*
 
 
Previous First Name*
 
 
Previous Middle Name
 
 
Previous Last Name*
 
 
New First Name*
 
 
New Middle Name
 
 
New Last Name*
 
 
Documentation Upload*
 
 
 
 
 
 
 
Please use the slider below to unlock the form in order to submit your request. This is so we can make sure you are not a robot.