Preferred Name Request Form

PreferredNameRequestForm
Instructions:
1. Fillouttheformclearlyandcompletely.
2. Signanddatetherequest.
3. Submitcompletedformto(NameofOffice)in(Building/Room).
NOTE:Preferrednamechangesareforfirstnamesonly.
FullLegalName:_____________________________________________________________________________
Last
First MiddleInitial/Name
UHIDnumber:_______________________________________
IrequestthatthefollowingnametoberecordedasmyPreferredFirstName*
PreferredFirstName__________________________________________
*Pleaseinitialhere__________toindicatethatyouhavereadandunderstandthe
following:
IamrequestingtheUniversitytousemypreferrednameonthefollowing
documents,records,andsystems:studentidentificationcards,classrosters,and
studentdirectoriessuchasLaulimaandSTAR.Iunderstandthatmyfulllegalname
willcontinuetobelistedonmyofficialacademicrecordandtranscriptasmyofficial
name.
IunderstandthattheRegistrarwillreviewthisrequestandwillnotifyme(viamy
uhemailsaccount)ifmyrequestisnotapproved.Requestsforpreferrednamesmay
bedeniediftherequestedpreferrednameisalreadyinuseorisinappropriate.
Notes:
- Specialcharactersarenotpossibleatthistime.
- ChargesmayapplytogetanewIDcard.
- Approvedchangesmaytake(lengthoftime)tobeineffect.
________________________________________________________
_________________
StudentSignature Date