March 1, 2017, Preferred_Name_Change w FERPA block
Office of the Registrar
Stevens Institute of Technology
Castle Point on Hudson
Hoboken, NJ 07030-5991
Preferred Name/Gender Identity Update
Last Name as it now appears in our system
First Name as it now appears in our system
Please use this form for changing your preferred name and gender identity ONLY.
This does not constitute a legal name change.
The preferred name will appear on class and grade rosters and will be used, except where the use of the legal name is required
for official documents e.g. transcripts, letters and diploma.
Preferred Name Update. Enter your preferred name as you want it to appear in our system.
Preferred Middle Name/Initial
There is a limit of 32 characters, including a comma and space between the Last Name and First Name, and a space between First Name and Middle Name/Initial in
the primary name field of our system.
Preferred Gender Update. Enter your gender identity as you want it to appear in our system.
STUDENT SIGNATURE DATE
REGISTRARS’ OFFICE DATE
click to sign
click to edit