Your First Name
Your Last Name
Your Email
I am filling out this form...
For myself
On behalf of someone else
What name do you use? (if different from the name you entered above)
What are your pronouns?
Phone
Is it okay to say we are calling from GLAD if we use this number?
Yes
No, please be discreet
What is the best way to reach you (if you listed both)?
Email
Phone
What state do you live in?
Connecticut
Maine
Massachusetts
New Hampshire
Rhode Island
Vermont
Outside New England
What city or county do you live in?
How did you learn about the ID Project?
For which items are you seeking assistance (check all that apply)?
Name Change
Social Security card
U.S. passport
Driver's license/state-issued identification card
Birth certificate
What state or jurisdiction is your birth certificate from?
Do any of the following apply? (Select all that apply)
I am incarcerated or formerly incarcerated
I am or am working with a system-involved youth
I am facing housing insecurity
I have heightened concerns around privacy or safety or face risk upon disclosure of my identity
I face barriers to completing name or gender change forms because of a disability
I have another specific concern related to my name/gender marker change that may require working with a lawyer [please describe below]
Please briefly describe your situation
What name do you use? (if different from the name you entered above)
What are your pronouns?
What is your relationship to the person on whose behalf you are completing this form?
Your Phone Number
Is it okay to say we are calling from GLAD if we use this number?
Yes
No, please be discreet
What is the best way to reach you (if you listed both)?
Email
Phone
How did you learn about the ID Project?
The following questions are about the person for whom you are submitting this form.
Their First Name
Their Last Name
What name do they use?
(if different from the name you entered above)
What are their pronouns?
Their Email
Their Phone Number
Is it okay to say we are calling from GLAD if we use this number?
Yes
No, please be discreet
What is the best way to reach them (if you listed both)?
Email
Phone
What state do they live in?
Connecticut
Maine
Massachusetts
New Hampshire
Rhode Island
Vermont
Outside New England
What city or county do they live in?
For which items are they seeking assistance (check all that apply)?
Name Change
Social Security card
U.S. passport
Driver's license/state-issued identification card
Birth certificate
What state or jurisdiction is their birth certificate from?
Do any of the following apply? (Select all that apply)
They are incarcerated or formerly incarcerated
They are or are working with a system-involved youth
They are facing housing insecurity
They have heightened concerns around privacy or safety or face risk upon disclosure of their identity
They face barriers to completing name or gender change forms because of a disability
They have another specific concern related to their name/gender marker change that may require working with a lawyer [please describe below]
Please briefly describe your situation