Name Change Certification Form

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I request that Washington and Lee the University (“University”) change the name on my official University records as follows:

Previous (First, Middle and Last) Name

Current/New (First, Middle and Last) Name

Years Attended University

Year of Graduation

Date of Birth (MM/DD/YYYY)

Student ID Number

Reason (Ex. marriage, court order, or other) for Change

I also request that the University change the gender on my official University records to align with my official government ID (or Court Order/Decree) as follows:

Female Male

I have provided the following documentation (check all that apply):

Copy of a Social Security Card, Driver’s License, Passport, Government or Military I.D. reflecting the change.

A certified copy of a court order reflecting the change.

A certified copy of a marriage certificate or dissolution decree reflecting the change.

For Current Students: I understand by submitting this form I agree that when the Office of the University Registrar makes the changes I have requested, it is my responsibility to notify others on campus, such as instructors of courses in which I am currently enrolled, of the change.

Submit completed form to Registrar at registrar@wlu.edu.