Skip to main content
Main navigation
Recertification
Application
Recertification FAQs
Requirements & Fees
Education Information
Auditing Information
Inactive & Emeritus Status
Certifications
Requirements & Applications
Verify a Credential
State-Certified Doula Registry
Education Review Form
Examinations
Information & Overview
Retest Form
Exam Prep for IC&RC Exams
Exam Verification Form
Education
Find Approved Education
Provider Status Forms
CCHW Training Approval Form
Doula Training Approval Form
CPRS Initial Training
Ethics
Ethical Violations
Ethics Complaint Form
Ethics FAQs
Guidelines for Filing a Complaint
Resources
Name Change Form
VA PRS Portal
Verification Request
International Certificate
Reciprocity
Email Request Form
VA Board of Counseling
Login
Name Change Form
First Name:
Last Name:
Email:
Documentation
I am uploading the following documentation of my name change:
- Select -
Marriage Certificate
Divorce Decree
Other Legal Documentation
Upload Files:
Upload
One file only.
100 MB limit.
Allowed types: pdf, .
Submit