NAME CHANGE REQUEST
Student/Employee ID Number: _________________
Legal First Name: _________________________ Legal Last Name: ___________________________
Email: _______________________________ Cell Phone: ___________________________
I am requesting a:
___ Chosen First Name: ____________________________
___ Preferred First Name: ____________________________
For an explanation of the difference between a "chosen name" and a "preferred name," please refer
to the guidelines posted on the "Forms and Guidelines" page.
GENDER IDENTITY CHANGE REQUEST
Gender Identity (choose one*):
_
_
_
_
_
_ Genderqueer/Gender
Fluid
_
_
_
Preferred Pronoun (choose one):
* Due to current limitations in the current information systems, only one choice can be entered.
By signing below, I confirm my understanding of the following:
I understand that there may be other systems that identify me by my legal name or legal gender marker that are
not listed above. I understand that the College makes every effort to respect the wishes of those who wish to be
known by chosen/preferred names and/or gender marker and that in some instances, my information may be
made available to others who have a need to know. I understand that I may present documentation to legally
change my name or gender marker at any time and will be asked to produce documentation to confirm such a
change. I understand that a separate form, Legal Name Change Form, should be used when I legally change my
name and will bring appropriate documentation.
My signature below indicates my willingness to have my chosen/preferred name and/or gender marker used in
most systems that identify me at Union College. I have the right to make a change to this request in writing at any
time.
Legal Name Signature/Date: __________________________________________________
Chosen/Preferred Name Signature/Date: ________________________________________________
Students: Please email the completed form to the Registrar’s Office registrar@union.edu
Employees: Please email the completed form to the Human Resources hr@union.edu
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
