Legal Name Change

Legal Name Change Request Form

Please review the Policy on Student and Alumni Name Changes

All requests must be accompanied by court ordered name change documentation. This can consist of the following: a court order, a legal marriage certificate, official divorce decree, a name change proceeding, an adoption proceeding, becoming a U.S. citizen, a witness protection program, or legal gender reassignment.

Students attending Mercy University on a student visa requesting a legal name change must provide a current passport bearing the exact same legal name as the new legal name in order for the University to change their student record.

Note that all legal name changes must be made by the student or alumni requesting the change. No second-party notification of a legal name change will be accepted

Legal Name Change

First Name*

Middle Name/Initial

Last Name*

CWID (Student ID Number)*

Email*

Phone*

Student Type*

Prospective Student Current Student Alumni or Former Student

Document Upload*

No File Chosen

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Requested New Legal Name

First Name*

Middle Name/Initial

Last Name*

Signature*

[clear]

Use your mouse or finger to draw your signature above

Date/Time*

:

Completed By(Registrar's Office)

Completed On