Change of Name Request

"*" indicates required fields

PERSONAL INFORMATION

Full Name currently on the University’s Repository of Student Information (ROSI) system:

First Name*

Last Name*

New name to be recorded and used:

First Name*

Last Name*

Student #*

D.O.B.*

MM slash DD slash YYYY

Email

Are you are a graduate?*

Yes

No

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Number of Degrees*

Please enter a number from 1 to 3.

Degree 1:

Name of Degree*

Date/Year Conferred*

Degree 2:

Name of Degree

Date/Year Conferred

Degree 3:

Name of Degree

Date/Year Conferred

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Reason for Name Change*

Changes to an officially recognized name in the student records of the University can only occur at the request of the name holder, who must present to the Student Services Officer one of the following original documents:

a birth certificate
a baptismal certificate
a marriage certificate
a change of name certificate issued to the Registrar General of Ontario

Please check if you expect to graduate within three months

Signature*

Date*

MM slash DD slash YYYY

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100 Wellesley St W, Toronto, ON M5S 2Z5
Land Acknowledgement: We wish to acknowledge this land on which the Regis St. Michael’s Faculty of Theology operates. For thousands of years it has been the traditional land of the Huron-Wendat, the Seneca, and the Mississaugas of the Credit. Today, this meeting place is still the home to many Indigenous people from across Turtle Island and we are grateful to have the opportunity to work on this land.

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