To update your name on your PDIS profile, please complete the information below and email to the PDIS Help Desk at . This statement must be signed and dated. New Name (Please print clearly) Former Name (Please print clearly) Birthdate: Email: Phone: I hereby certify that I have completed the legal process to change my name. I understand that providing false information can result in suspension of my PDIS account and revocation of my Early Childhood Professional Credential. Signature: Date: Please for one business day to process this request. If you have any questions, please email at the address above or call us at 844-447-4441 option2.
To update your name on your PDIS profile, please complete the information below and email to the PDIS Help Desk at . This statement must be signed and dated. New Name (Please print clearly) Former Name (Please print clearly) Birthdate: Email: Phone: I hereby certify that I have completed the legal process to change my name. I understand that providing false information can result in suspension of my PDIS account and revocation of my Early Childhood Professional Credential. Signature: Date: Please for one business day to process this request. If you have any questions, please email at the address above or call us at 844-447-4441 option2.
Name%20Change%20Attestation%20Statement%202.3.17.docx