Enter your desired full name, as it will appear on the MITx Certificate:
<p><inputid="new_name"value=""/>
<p>Reason for name change:
<p><inputid="name_rationale"value=""/>
<p>A member of the course staff will review your request, and if approved, update your information.
<p><inputid="submit">
<form>
<fieldset>
<ul>
<li>
<label>Enter your desired full name, as it will appear on the MITx Certificate: </label>
<inputid="new_name"value=""type="text"/>
</li>
<li>
<label>Reason for name change:</label>
<textareaid="name_rationale"value=""></textarea>
</li>
<li>
<label>A member of the course staff will review your request, and if approved, update your information. Please allow up to a week for your requested to be processed.</label>