Revised 3/23/2020
Registrar's Office
501 Crescent Street
New Haven, CT 06515-1355
Phone: 203-392-5301
Fax: 203-392-7144
Email:Registrar@SouthernCT.edu
Web: OneStop.SouthernCT.edu
Legal Name or
Gender Change
Connecticut State Colleges and Universities must use students’ legal names and gender in all official documents. Legal names
and gender appear on all external use reports and documents including, but not limited to employment paper work,
paychecks, tax forms, student billings, financial aid forms, scholarships, transcripts, and other documents required by law. This
form will change all records maintained by the Registrar’s Office, including subsequent credentials conferred by the institution.
Directions: Complete and submit this form, along with one of the acceptable legal documents from the list below, and a copy
of a government or school issued photo ID if not already contained in the legal document provided. The Registrar’s Office may
accept as legal documentation: 1) federally- recognized identifications (i.e. passports); 2) state verified driver licenses; 3) court
orders arising from a name change proceeding, an adoption, a divorce decree, individual choice or witness protection
program, and marriage licenses as documentation of identity for legal name change process. An unverified state driver
license, also referred to as a Drive Only License,” may not be used for this purpose since its issuance relates to the ability to
drive a vehicle, and it does not establish legal identity.
In the event of a typographical or other error in institutional records or documents, the individual’s request to correct the
name will be granted after verification that the correction is due to an error. Documents that may provide sufficient
verification for determination of the correction include birth certificates, social security cards, driver’s licenses, and other
documents issued by federal, state and local governmental agencies.
Personal Information:
Student ID Number: ________________________________ Birth Date: _____________________________________________
Current Name as it appears now on records: ____________________________________________________________________
New First Name: _____________________________ Middle: ___________________ Last: _____________________________
(Include hyphens, apostrophes, commas, periods, and spaces. Other special symbols cannot be entered onto your records.)
Legal Gender as it appears now on records:
New Legal Gender:
Phone: _____________________________ Email Address: _______________________________________________________
By my signature below, I affirm that I am the above named person and that the information presented is true.
Student Signature: _____________________________________________________ Date: _____________________________
Note: Students may create a digital ID using their SCSU email by clicking the signature block above, or the form may be
accepted as an attachment from their SCSU email without a signature.
Male Female
Male Female
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signature
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