SUNY Polytechnic Institute Chosen Name Request Form

To request a chosen first name, please complete this form in its entirety, any missed information will delay the processing of the request. Once the request is received it will be reviewed for approval and if approved updates will be initiated in the following systems:

-Class Rosters

-Athletics

-SUNY Poly Email Display Address

-Brightspace

-SUNY Poly ID Card

-SUNY Poly Directory

-Degree Works

-SUNY Poly Engage

-The Housing and Dining Portal

-Banner

-Wildcat Wellness Student Portal

You will be contacted via your SUNY Poly email to let you know if your request was approved and when to expect your information to be updated. If your request is denied you will be informed via your SUNY Poly email and you will be provided with information on how to appeal the decision.

Please Indicate which of the following you identify as:

Current SUNY Poly Student

Faculty

Staff

Other

Your Legal Name(Required)

First Last

Banner U#(Required)

Your Address(Required)

Street Address Address Line 2 City State ZIP Code

Your Choosen First Name(Required)

First

Preferred Pronouns(Required)

Your SUNY Poly Email Address(Required)

SUNY Poly Email Address Confirm Email Address

Your Phone(Required)

Date of Birth(Required)

Is there anything regarding your chosen name that you feel the committee should be aware of?

Name

This field is for validation purposes and should be left unchanged.