The Name Change Request Form is the Montana Board of Nursing's name change form for licensees who need the name on their license updated. It sits among the licensing board forms of the Montana Department of Labor and Industry, Business Standards Division. You complete your license number, date of birth, Social Security number and new name, sign it, and send it with a copy of a document that shows the new name. On FillingPDF you can fill out the form online and download or print the completed PDF; the Board receives it only by fax, email or postal mail.
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What is Name Change Request Form – Montana?
The Name Change Request Form is the one-page Montana Board of Nursing form used to ask that the name shown on your license be changed. It is published by the Board of Nursing within the Montana Department of Labor and Industry, Business Standards Division.
The form collects the details the Board needs to find your record and make the change: the current name on the license, the license number, your date of birth, your Social Security number, the name you want the license to show, a daytime or cell phone number, an email address, your signature and the date. The license number, date of birth and Social Security number are marked "Required" on the form.
The form does not work alone. It states that you must provide a copy of one document with it: a Social Security card or a driver's license that displays your new name, or the document by which your name was legally changed, such as a marriage license or divorce decree. The Board lists a fax number, an email address and a postal address for returning the completed form.
It is a request to change the name on an existing license. The form does not describe it as an application for a new license.
Who needs to file Name Change Request Form – Montana?
Anyone who holds a license with the Montana Board of Nursing and wants the name on that license changed uses this form. The form opens with the sentence "To have your name changed on your license," so the audience is licensees whose name no longer matches their license record.
The supporting document you choose must show the new name or prove the legal change. The form gives examples of a legal name change document: a marriage license or a divorce decree. A Social Security card or driver's license is accepted only if it displays your new name.
You need to know your license number, which the form marks as required. If you do not know it, the form tells you to go to www.nurse.mt.gov and use Lookup License.
The form has a single signature line for the person making the request. It names no representative who may sign for you and sets no exclusions, so questions about who else may act for you should go to the Board at (406) 444-6880.
When to file Name Change Request Form – Montana
Submit the form when you want the name on your license changed, after you have a document that shows the new name, such as an updated Social Security card or driver's license, or the legal name change document. The form prints no deadline, renewal date or processing time, so it is not tied to a due date of its own.
Because the form is returned together with a copy of your supporting document, wait until you hold that document before you send the request. For questions about timing, the Board lists a phone number of (406) 444-6880.
Documents you need
- A copy of a Social Security card that displays your new name, if you use it as your supporting document.
- A copy of a driver's license that displays your new name, if you use it as your supporting document.
- A copy of the document by which your name was legally changed, such as a marriage license or divorce decree, if you do not use a Social Security card or driver's license.
- If you send the form by email, the supporting document must be attached to the email as a scan.
How to fill out Name Change Request Form – Montana
Enter your current name
In the Current Name on License line, write your name exactly as it now appears on your Board of Nursing license.
Enter your license number
Fill in License Number (Required). If you do not know it, go to www.nurse.mt.gov and use Lookup License.
Enter your date of birth
Fill in Date of Birth (Required).
Enter your Social Security number
Fill in Social Security Number (Required).
Write the new name
In the Change Name to line, enter the full name you want shown on your license. It should match the document you attach.
Add phone and email
Enter a Daytime Phone or a Cell Phone number, and your Email Address, so the Board can reach you.
Sign and date the form
Sign on the Signature line and enter the Date.
Choose your supporting document
Prepare a copy of one document: a Social Security card or driver's license displaying your new name, or the document that legally changed your name, such as a marriage license or divorce decree.
Review and download the completed PDF
Check that the required lines are filled and the name matches your document. Download or print the completed PDF from FillingPDF, then send it with the document as described under How to submit.
How to submit Name Change Request Form – Montana
You can return the completed Name Change Request Form to the Board of Nursing by fax, by email or by postal mail.
- Fax: (406) 841-2305.
- Email: [email protected]. The form says to attach and scan in your supporting documents when you send it by email.
- Mail: Board of Nursing, 301 South Park, PO Box 200513, Helena, MT 59620-0513.
Whichever channel you use, include a copy of one supporting document: a Social Security card or driver's license displaying your new name, or the document by which your name was legally changed. The form lists the Board's phone number as (406) 444-6880. It names no in-person option and no online portal.
FillingPDF lets you fill out and download the PDF; submission follows the channels above.
Common mistakes to avoid
- Sending the form without a copy of a supporting document; the form asks for one of the three listed documents.
- Using a Social Security card or driver's license that still shows your old name; the form says it must display your new name.
- Leaving out the license number, date of birth or Social Security number, which the form marks as required.
- Not knowing your license number and guessing it; the form points you to Lookup License at www.nurse.mt.gov.
- Emailing the form without attaching scanned copies of your documents; the form says documents must be attached and scanned in.
- Leaving the signature or date blank on the form.
- Sending the request to an address other than the fax, email or Helena mailing address printed on the form.
Frequently asked questions
What is the Montana Board of Nursing name change form?
It is the Name Change Request Form that the Montana Board of Nursing uses to change the name shown on your license. You complete your license details and new name, sign it, and send it with a copy of one supporting document.
What documents do I need to send with the name change form?
A copy of one document: a Social Security card or driver's license that displays your new name, or the document that legally changed your name, such as a marriage license or divorce decree. Send just one of these with the form.
Where do I send the Board of Nursing name change request?
By fax to (406) 841-2305, by email to [email protected] with scanned documents attached, or by mail to Board of Nursing, 301 South Park, PO Box 200513, Helena, MT 59620-0513.
How do I find my license number for the form?
The form says to go to www.nurse.mt.gov and use Lookup License if you do not know your license number. The license number is marked as required, so find it before you complete the form.
Is my Social Security number required on this form?
Yes, the form marks Social Security Number as required, along with the license number and date of birth. Because it asks for this, send the form only through the fax, email or mail channels the Board lists.
Can I fill out the Name Change Request Form online?
Yes. You can fill out the PDF online on FillingPDF and download or print it. FillingPDF is an independent service and does not send the form to the Board; you submit it by fax, email or postal mail.
Can I use my new driver's license as proof of my name change?
Yes, if it displays your new name. The form accepts a driver's license or Social Security card showing the new name, or the legal name change document, such as a marriage license or divorce decree.
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