UMPI Legal Name Change Request Form 

Submission request form for legal name change required of UMPI Office of Student Records. A student who wishes to change his/her legal name in UMS’s Student Information System must provide a copy of one of the following documents showing the new name. The Office of Student Records will not process your request to change your name unless the required document accompanies this form via email to umpireg@maine.edu. 

Please allow two week’s minimum for processing of all requests. Contact: (voice) (207) 768-9540 or (email) umpireg@maine.edu (fax) (207) 768-9458 

UMPI Legal Name Change Request Form
Former Name: First, Middle, Last
Former Name: First, Middle, Last
First
Middle
Last
New Name: First, Middle, Last
New Name: First, Middle, Last
First
Middle
Last

Please specify the type of documentation you have provided: (Marriage Certificates are not accepted as official documentation). You must upload a high resolution scan of the document you select in this form to umpireg@maine.edu. We advise using a scanner app if you are using a cellphone.

Document Type

Have you scanned and emailed the document type you selected to our email umpireg@maine.edu?

 If you have not please take the time to do so now and then check the Yes box once you have

Acknowledgement

By entering my electronic signature below in this form, I hereby grant and authorize the University of Maine System, acting through the University of Maine at Presque Isle, (hereinafter UMPI) its employees and agents to make use of, or assign the use of my legal information for the purposes of my educational record(s). I agree to indemnify and hold UMPI, UMS, the University, its employees and agents, harmless from and against any and all claims, damages, lawsuits, judgments, and expenses, including reasonable attorneys’ fees, that UMS may become liable to pay or defend arising out of or caused by any matter or material furnished or spoken by me in connection with my request. I hereby release UMPI, UMS, its employees and agents from all expenses, claims and liabilities incurred by me arising out of or in connection with the use of the material, except to the extent that those expenses, claims or liabilities are the direct result of the negligent acts or omissions of  UMPI, the University of Maine system, its employees or agents. This agreement shall be governed and construed according to the laws of the State of Maine.
Please type your name (first, middle, last as a digital signature) and add the date 
Please type your name (first, middle, last as a digital signature) and add the date 
First, Middle, Last Name
Date