Name Change Request
Registrars Oce
300 Tory Building, 1125 Colonel By Drive, Ottawa, ON, K1S 5B6
fax: (613) 520-4410
tel: (613) 520-3500
By subming this form, you acknowledge that you have read the following privacy noce.
Name (currently on record): Status:
Current or former student:
Special Student
Student Number:
Phone Number:
Opon 1: Legal Name Change Request on Academic Records
For students who would like to change the name they currently have on record at Carleton University.
Name Change Types:
Change to Last Name Change to First Name
Addion/Removal of Middle Name Alteraon to spelling of name(s)
Documentaon Required. You must provide an original copy of one of the documents listed below. If the document is not in English, you must provide a
cered translaon of it.
If you are a Canadian Cizen or Canadian Permanent Resident:
Provincial Name Change Cercate
Drivers License
Canadian Passport
Canadian Cizenship Card
Cercate of Indian Status
Permanent Resident Card
Marriage Cercate
If you are a Non-Permanent Resident:
Internaonal Passport
Canadian Study Permit
Canadian Work Permit
Canadian Immigraon Documentaon
Marriage Cercate
Requested Legal Name Change:
First Middle Last
Opon 2: Change Gender Assignment
No documentaon is required to change gender assignment.
Male Female Other Prefer not to report
Opon 3: Request for Variaon of Diploma Name
Please be sure that you have applied to graduate online before compleng a request for variaon of diploma name.
Below are the ONLY Change Types Permied (no documentaon required).
Change my middle name to an inial (e.g., Mary Ann Smith to Mary A. Smith)
Remove my middle name (e.g., David Brian Smith to David Smith)
Change a leer to an Upper or Lower case (e.g., Mckay to McKay)
Add an accent to my name (e.g., Renee Cote to Renée Côté)
Use my preferred rst name
Requested Diploma Name:
First Middle Last
I conrm that the statements made on this document are true and accurate.
Signature: Date:
When compleng this form, please use the appropriate upper and lower case characters as they appear on your supporng documentaon.
Oce Use Only (comments):
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