Name Change Request
300 Tory Building, 1125 Colonel By Drive, Ottawa, ON, K1S 5B6
fax: (613) 520-4410
tel: (613) 520-3500
By subming this form, you acknowledge that you have read the following privacy noce.
Name (currently on record): Status:
Current or former student:
Opon 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
Addion/Removal of Middle Name Alteraon to spelling of name(s)
Documentaon 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
cered translaon of it.
If you are a Canadian Cizen or Canadian Permanent Resident:
Provincial Name Change Cercate
Canadian Cizenship Card
Cercate of Indian Status
Permanent Resident Card
If you are a Non-Permanent Resident:
Canadian Study Permit
Canadian Work Permit
Canadian Immigraon Documentaon
Requested Legal Name Change:
First Middle Last
Opon 2: Change Gender Assignment
No documentaon is required to change gender assignment.
Male Female Other Prefer not to report
Opon 3: Request for Variaon of Diploma Name
Please be sure that you have applied to graduate online before compleng a request for variaon of diploma name.
Below are the ONLY Change Types Permied (no documentaon required).
Change my middle name to an inial (e.g., Mary Ann Smith to Mary A. Smith)
Remove my middle name (e.g., David Brian Smith to David Smith)
Change a leer 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 conrm that the statements made on this document are true and accurate.
When compleng this form, please use the appropriate upper and lower case characters as they appear on your supporng documentaon.
Oce Use Only (comments):
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