Acknowledgment and Agreement

Select an Option I understand and agree to the instructions above.

I am...

An individual 18 years of age or older who is seeking to file a petition to change a name and/or gender marker.

The parent or guardian of a minor (under 18) who is seeking to change their name and/or gender marker.

Considering a legal name and/or gender marker change for myself or on behalf of my child. I'd like to seek more information from an attorney at the clinic and do NOT want documents drafted at this time.

Contact Information (Preferred Name)

Applicant's pronouns:

The Applicant to the project is the person seeking a legal name and/or gender marker change.

Applicant's (you, or your child if petitioning on their behalf) connection to Texas:

I live in Texas currently

I do not live in Texas, but I was born in Texas

I am not in Texas currently, but my permanent residence is in Texas

I have no connection to Texas

I (the applicant) want to change my: name, gender marker, or name and gender marker on legal documents.

Note: Texas does not recognize nonbinary or third gender markers on legal documents [i.e., you may only correct your documents to read “male” or “female” – some other states allow a third option, such as an “X”]. We hope this will change!

Name

I want my full legal name to be:

If you are debating between just a name change and a name AND gender marker change, please select the latter option on this form. You will be able to discuss the process with an attorney during the clinic and we can always remove this language if you change your mind.

Gender Marker

I want to change my gender marker to:

Name and Gender Marker

I want to change my gender marker to: I want my full legal name to be:

Have you completed this survey before?

No problem if you have - you can complete it again! We just need to make sure we don't schedule you twice.

Yes

No

Do you need a Spanish-speaking volunteer or any accommodation to participate in a Zoom clinic?

Spanish-speaking volunteer needed

Other accomodation needed:

What additional accommodation is needed?

No specific language or other needs.

Information for Court Documents: All Applicants

Applicant's gender identity:

Applicant's current legal name:

Applicant's current legal sex:

Applicant's date of birth:

Last 3 digits of Applicant's Driver's License number and issuing state (e.g. 123-TX), or enter "none"

If you have a DPS State ID, enter the last three digits and note this is a Texas DPS State ID.

If Applicant has any other forms of ID issued in the last 10 years, please describe and give the last 3 digits of each (examples: state ID, ID or DL issued in another state, work permit / EAD, military ID):

Last 3 digits of Applicant's Social Security Number (or, "No SSN")

Applicant was born in (City, County, State, Country):

Applicant's Race as listed on birth certificate (if not listed on birth certificate, applicant's race as self-identified):

Have you/the applicant, ever been charged with an offense above a class C misdemeanor? (This does not mean you can't get a court order, we just need to ask for additional information.)

Yes

For each offense charged please list as much information as you can about: 1) the offense charged, 2) the state, 3) the county, 4) the court (District or County Court and the number), and 5) the cause number (or case number)

If you are unsure of this information, please try and at least list the county. This makes it easier for us to prepare your documents.

No

Please skip this section if the applicant (person seeking a name and/or gender marker change) is an adult, over 18 years old.

Parents/guardians may petition for a name and/or gender marker change for a minor child. Applicant's custodians are:

2 parents/guardians, filing together

1 parent/guardian, and no other person has a parental relationship with, or custodial interest in, the child

1 parent/guardian, and another person has a parental relationship with, or custodial interest in, the child

Please describe:

Are there any court orders regarding the child?

This could be, for example, a court order in a divorce that sets child custody and/or visitation, or a previous name and/or gender marker change order.

No

Yes

Please describe, including the cause number, court, state, and county of any court order(s) regarding the child, and a brief description (examples: "divorce and child custody," or "adoption of a minor child"):

Parent 1 Full Name:

Parent 1 Email Address:

Parent 1 Phone Number:

Parent 1 Mailing Address (including city, state, zip):

Last 3 digits of Parent 1 Driver's License (please note if an ID or issued in a state other than Texas, etc, or "no DL"):

Last 3 digits of Parent 1 Social Security Number (or "No SSN"):

Parent 2 Full Name:

Parent 2 Email Address:

Parent 2 Phone Number:

Parent 2 Mailing Address (including city, state, zip):

Last 3 digits of Parent 2 Driver's License (please note if an ID or issued in a state other than Texas, etc, or "no DL"):

Last 3 digits of Parent 2 Social Security Number (or "No SSN"):