DATE:
March 20, 2019
TO:
Principals
Assistant Principals
Administrative Assistants
FROM:
Administrator of Schools
Dr. Anthony Godfrey, Associate Superintendent
Travis Hamblin, Planning & Student Services
SUBJECT:
Name Change Affidavit and Certification
Utah Administrative Code R277-419-10(4) allows schools to use a name other than what appears on a birth certificate provided the parent(s)/legal guardian(s) aver that there is a compelling need to protect their child.
When parent(s)/legal guardian(s) request such action, schools shall provide them with the “Name Change Affidavit and Certification” form. This form is found online at http://planning.jordandistrict.org/resources/school/. Once the form is completed and notarized it is returned to the school and the change is made in Skyward as though the student’s birth certificate had been changed. Place the original in the student’s cumulative folder and provide a copy for the parent(s)/legal guardian(s).
The new name identified on the form will be used as the official name designated on Jordan School District’s official transcripts and records. The “Name Change Affidavit and Certification” form does NOT constitute a legal name change.
After the name is changed in Skyward the school shall contact Information Systems who will update the student’s state SSID information.
Xc:
Name Change Affidavit and Certification
