University of Arkansas for Medical Sciences Logo University of Arkansas for Medical Sciences
Division for Diversity, Equity, and Inclusion

Name Change Request Form

Name Change Form

UAMS recognizes that some individuals have a strong preference to use and be known by a name other than their Legal Name for reasons related to their gender identity, cultural background, or for other social or personal reasons. UAMS shall permit employees and students to designate, use, and be known within the UAMS community by a Preferred Name, to the extent that doing so is consistent with law, assures the integrity of UAMS official records, and is reasonably feasible to accommodate within the UAMS record-management systems. An application for change of name may be denied if the change is determined to be inconsistent with law or with other UAMS policies or damaging to, or not in the best interest of, UAMS, its students, or employees.
Legal Name
Legal Name shall mean the name that is recognized by state and/or federal law as an individual’s legal identification.
Designation
Please select your designation.

Preferred Name:(Required)
Preferred Name shall mean a name different than an individual’s Legal Name that the individual selects and that UAMS approves for use within the UAMS environment. Using the fields below, input the preferred name you are requesting to replace your legal name on: - University ID card/badge - Student and Employee directory information - Class lists and grade reports (i.e., GUS) - Advising lists - Learning management systems (i.e., Blackboard, My Compass, Workday, etc.) - Building/service access systems
Reason for Request(Required)
Please select the most appropriate reason(s) for your request: