1/12/2017
Student Name Change
Registrars Office: Capin Hall 165 S. Franklin St. Wilkes-Barre, PA (P) 570-408-4961 (F) 570-408-4004 (E) registrar@wilkes.edu Mailing
Address: Wilkes University, 84 W. South St. Wilkes-Barre, PA 18766
Preferred Name Change:
In support of Wilkes University's commitment to provide an
equitable and safe experience for students whose birth name
and/or legal name does not reflect their gender identity or
expression, Wilkes accepts requests from such students to use
a preferred first and/or middle name on certain University
records. A student's preferred name will be used where
feasible in all University systems unless the student's birth
name and/or legal name is required by law, deemed necessary
by University policy, or the student's requested name is
determined to be for intent of misrepresentation.
Process:
To start the process of requesting a preferred name and/or
gender marker change, fill out this form completely and email it
to registrar@wilkes.edu from your Wilkes University email
address, or return it to the Registrar's Office in person.
For questions or to discuss the process, students may contact:
Ms. Susan A. Hritzak
Registrar
susan.hritzak@wilkes.edu
Ms. Samantha E. Hart
Title IX Coordinator
samantha.hart@wilkes.edu
Legal Name Change:
Designating a preferred first and/or middle name for use at
Wilkes University does not constitute a legal name change. In
the event a student, by court order, marriage, divorce, etc.,
changes their legal first, middle, and/or last name, the student
should contact the Registrar's Office for further instruction.
Accompanying documentation will be requested to effectuate
this change.
WIN:
Legal Name:
First:
Middle:
Last:
Requested Name:
First:
Middle:
Gender Marker:
¨ Woman ¨ Man ¨ Other gender identifier (e.g.
intersex, gender non-binary,
gender fluid):
__________________
Wilkes Email: (Banner, Rosters, and D2L Live will
also be updated unless you indicate otherwise)
¨ Yes, I would like to learn more about updating my
student email to reflect my requested name.
¨ No, I would not like to update my email at this time.
Date:
Email this completed form to registrar@wilkes.edu from your
“@wilkes.edu” email in order to verify your identity.
The Registrar's Office will work with the relevant campus
offices in updating your requested information.
Prefer not to disclose
Wilkes ID Card:
¨
Yes, I would like to receiv
e an updated ID Card with
my
req
ues
ted name display
ed.
¨ No, I
would not like a
new ID card.
