REGISTRAR’S OFFICE USE ONLY
Processed By: ___________________________ Date: ______________________
PREFERRED NAME CHANGE FORM
University of Kentucky allows a first and/or middle name to be used by students, faculty, and staff to indicate
their preferred name to the university community regardless of whether they have legally changed their name.
Legal last names can’t be changed with this form. Your preferred name will appear on your myUK portal and
class rosters.
Note: Names on your diploma are chosen at the time of your degree application. Email aliases may be selected
by the student through the use of UK’s Account Manager. This form can also be used to facilitate an updated
preferred name on your UK ID Card. Questions about preferred name can be directed to the Registrar’s Office or
the Office of LGBTQ* Resources.
LEGAL Name: ____________________________________________________________________________
First Middle Last
PREFERRED Name: ________________________________________________
First Middle
Student ID Number: _______________________ Date of Birth: _______________________
If you would like to designate a gender marker that differs from your legal gender, please fill out the information
below.
G
ender Identity: Male Female Write in: _______________
Pronoun: He She Write in: _______________
Certification
Please read the following carefully and sign below to acknowledge you have read and accept the certification.
I certify that I fully understand the above purpose of the Preferred Name Change Form. I understand that my
preferred name is defined as the sole name that will be used for professional purposes at the University of
Kentucky. I understand that my preferred name, gender identity and pronoun change will be reflected in many
university systems but understand that implementation in some systems may not yet be possible. Furthermore,
I confirm that I am not requesting a preferred name, gender identity or pronoun to avoid any legal obligation or
to otherwise misrepresent myself.
______________________________ _____________________________ _______________
Print Legal Name Sign Legal Name Date
