Gender Expression and Gender Identity Form Date: To The

Gender Expression and Gender Identity Form
Date: _______________
To The Registrar’s Office:
I, ____________________ (Student Name), student number ________________ (Student
Number), request that my first name be changed to ________________ (Name) on the
Algonquin College Student Information System. I also request that my noted gender be
changed from ___________________ (Female or Male) to _______________ (Female, Male
or Undeclared).
I understand that this name change on my student record is not a recognized formal legal name
change for any future employers, licensing bodies, governmental or non-governmental
organizations, including educational institutions that may require proof of legal name or gender
change documentation.
Sincerely,
_________________________________
Signature
Note: Please complete this form and present it in-person to the Registrar’s Office. You must
provide valid Government Issued photo identification that matches the information currently
noted on the Algonquin College Student information system. Once the ID has been validated
and this completed authorization is received, your student record will be updated. Please allow
48 hours before you request a replacement Student Card.
This authorization will be added to your student file.
The Registrar's Office can arrange a private setting for the submission of this form. Please
email [email protected] to make a request for an appointment.
RO095
June 2016