Trans Legal Aid Clinic-Houston Intake Form
The information you enter here will be collected in a secure Google drive. We will never share or sell any of your information. All of the data is necessary for the completion of the petition and order required to file for your name and/or gender marker changes, so it is very important that all of the information is entered correctly and truthfully.

If the name and/or gender marker changes are for a minor, make sure to list the minor's information on this intake form; parent/guardian information will be collected in Section 3.

You will get the virtual attendance info emailed to you no later than the Wednesday before the clinics. The information will be emailed to the email address you have provided (please remember to check your spam folder if you don't see our email).
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Email *
Chosen First Name *
Chosen Middle Name *
Chosen Last Name *
Pronouns *
Sex Assigned at Birth
Clear selection
Gender/Sex by Which You Identify
Clear selection
Want to update... *
Current Legal First Name *
Current Legal Middle Name *
Current Legal Last Name *
Date of Birth (MM/DD/YYYY) *
Place of Birth; City, County, and State (and Country, if outside the U.S.) *
If your race is listed on your birth certificate, what is your listed race? *
If your race is not listed on your birth certificate, by which race do you identify? *
Home Address: Street *
Home Address: City *
Home Address: State *
Home Address: Zip Code *
Home Address: County *
Phone Number *
Social Security Number *
Driver's License or Identification Number *
Which state issued your driver's license or identification number? *
Have you had any other driver's license numbers or identification numbers in the last 10 years? *
If yes, what are they and in which state(s) were they issued?
Which clinic date will you be attending? *
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