AC-E6

File:  AC-E6 (pdf)
Revised: August 27, 2019

---

STUDENT GENDER, FIRST NAME, AND/OR MIDDLE NAME CHANGE REQUEST FORM

This form is to be used in the absence of legal documentation when gender, first name, and/or middle name changes are requested. The student’s legal first name and gender will be maintained in a protected area along with historical records referring to this information. These historical records will only be updated upon presentation of legal name change documentation. This information will only be shared with staff when requested by the legal guardian.

PLEASE NOTE: When student records are requested the legal name and/or gender may be revealed if they were indicated in previous records and we have not been presented with legal documentation to change them accordingly.

I hereby request that

Student’s Legal Name/Gender:

______________________________________________________________________________
First Name, Middle Name, Last Name                          Suffix              Gender

be changed in the BVSD Student Information System to:

Student’s Assumed Name/Gender:

______________________________________________________________________________
First Name, Middle Name, Last Name                          Suffix              Gender

If you are requesting use of an assumed first and/or middle name, you may wish to proceed with a legal name change. Information for requesting a legal name change may be found at: http://www.courts.state.co.us/Forms/Forms_List.cfm?Form_Type_ID=26

Additional Information is available at: http://www.namechangeproject.org.

Parent/Guardian Signature:

_____________________________________________          Date:___________________

End of File: AC-E6