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Name Change Form

This form may be used by current students and/or alumni to change their legal name as it appears on their permanent record. This change will require specific documents to do so.

  • SUNY Brockport
    Office of Registration and Records
    350 New Campus Drive, Rakov 201
    Brockport, NY 14420
    Ph: 585.395.2531/Fax: 585.395.5392
    Email: registrar@brockport.edu

  • Two forms of acceptable documents will be required along with receipt of this completed form.
    One form of documentation must be either a marriage certificate or a court order, the second form, a photo ID.

    INSTRUCTIONS
    *Do not use Internet Explorer
    *Fill out form
    *Submit form (Click "Submit" button after completing form)
    *A receipt will be sent to the email entered on the form
    *Print out the emailed receipt and submit it, along with the acceptable documents, to The Office of Registration and Records
    *Forms and documents will be accepted by mail, email, fax, or walk-ins
    *Your request will be processed after the receipt and acceptable documents are received by the Office of Registration and Records
    Please Note: When submitting personal documents, only the last 4 digits of your SSN is needed.
    If you have any questions, please email registrar@brockport.edu

  • STUDENT INFORMATION
    Enter your name as it currently appears on the college records:

  • COMPLETE NEW NAME:

  • Must be between 4 and 9 digits.   Currently Entered: 0 digits.

    DO NOT enter your complete SSN

  • Draw or Type
    I understand this is a legal representation of my signature. Clear
  • Your receipt will be sent to the email address you enter here.

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