Revised 4/23/2018
Newburgh Campus 1 Washington Center, Newburgh, NY 12550
Middletown Campus 115 South Street, Middletown, NY 10940
(845) 341-4140 ●
Preferred Name Change Form
**For Registrar Use Only**
Process Date ___________________
Initials _________________________
Student Information:
A#: __________________________________ Date of Birth: ________________________________
Legal Frist Name: _______________________ Legal Last Name:_____________________________
Preferred First Name: ________________________________________________________________
SUNY Orange recognizes that many students, faculty, and staff prefer to use first names other than their
legal ones to identify themselves. As long as the use of this preferred name is not for the purpose of
misrepresentation, the college acknowledges that a “preferred name” can and should be used where possible
in the course of college business and education. All official college correspondence will use your legal
name. Please note: the preferred name is used solely for SUNY Orange’s internal systems. Official
transcripts, enrollment verifications, third party database systems, and all external communications, such as
hometown newspapers (dean’s list announcements), etc., will continue to use your legal name. Your
preferred name can be changed no more than once an academic year and twice during your tenure at SUNY
Orange. Disclaimer: This policy does not form a contract of any kind and may be modified, changed,
altered, or rescinded at the discretion of SUNY Orange. Inappropriate use of the preferred name, including
but not limited to misrepresentation or attempting to avoid a legal obligation, may be cause for denying the
Student Signature: My signature authorizes SUNY Orange to change my preferred name. I understand that
this process will not change my legal name with the College and that any official documents released from
the College (official transcript, etc.) will be issued using my legal name.
Signature: ___________________________________________________________Date: _________
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