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Summary: Student Number: _______________________ Faculty or School: ________________________________________
Name information CURRENTLY on database:
Student Name: _______________________________________________________________________________
Title Surname Given Names
POLICY: As the University is committed to the integrity of its student records, each student is required to provide either on
application for admission or on personal data forms required for registration, their complete legal name. Any requests to
change a name, by means of alteration, deletion, substitution, or addition must be accompanied by appropriate supporting
documentation. Our full names policy is available at http://www.queensu.ca/registrar/aboutus/policies/names.html
Appropriate documents are defined as follows:
· Birth or baptismal certificate
· Marriage / Separation / Divorce documents
· Passport
· Change of Name Certificate as issued by a Court, or
· A Statutory Declaration Form
CHANGE TO:
__________________________________________________________________________________________________
Title Surname Given Names:
___________________________________________________________________________________________________
Reason (Marriage, Divorce, Middle Name missing, etc.)
PLEASE NOTE: Deadlines for changes or corrections for Degree List purposes must be received at the address below
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