Fillable AreyouastudentofTTUHSCoranemployeeofTTUHSC?(pleasecheckone) Nameand/orSocialSecurityNumberChangeRequest (AclearcopyofyournewSocialSecurityCardwillbe required) (Texas Tech University-Health Sciences Ce

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AreyouastudentofTTUHSCoranemployeeofTTUHSC?(pleasecheckone) Nameand/orSocialSecurityNumberChangeRequest (AclearcopyofyournewSocialSecurityCardwillbe required) (Texas Tech University-Health Sciences Center)

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Nameand/orSocialSecurityNumberChangeRequest
(AclearcopyofyournewSocialSecurityCardwillbe
required)

AreyouastudentofTTUHSCoranemployeeofTTUHSC?(pleasecheckone)
CurrentlyEnrolledStudent________ Employee_________
Semesterlastenrolled:____________
Pleasechangemyinformationasindicatedbelow:
NEWFullLegalName:

_________________________________ ___________________ _________________________________
NewLastNewFirstNewMiddle
OLDFullLegalName:
_________________________________ ___________________ _________________________________
OldLastOldFirstOldMiddle
NEWSocialSecurityNumber:______________________
OLDSocialSecurityNumber: _______________________
Pleasemail,fax,e‐mail,orbringcompletedformwith
aclearcopyofyourNewSocialSecu rityCardto:
ForEmployees:
HumanResourcesBenefits
HSCBenefits@ttuhsc.edu
Room1B211
MailStop8100
Lubbock,TX79430
Telephone:(806)743‐2865
Fax:(806)743‐2882




ForStudents:
OfficeoftheRegistrar
Registrar@ttuhsc.edu
Room2C400
MailStop8310
Lubbock,TX79430
Telephone:(806)743‐2300
Fax:(806)743‐3027
Signature(Required ):___________________________________________Date:______________
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AreyouastudentofTTUHSCoranemployeeofTTUHSC(pleasecheckone) NameandorSocialSecurityNumberChangeRequest (AclearcopyofyournewSocialSecurityCardwillbe required) (Texas Tech University-Health Sciences Center)

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Completed 24 July 2020

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