Fillable ChangeofPersonal Informaon StudentAairsAdmissions/Records/EnrollmentServices 4501AmnicolaHwy.,Chaanooga,TN374061097 Return this Application as (Chattanooga State Community College)

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ChangeofPersonal Informaon StudentAairsAdmissions/Records/EnrollmentServices 4501AmnicolaHwy.,Chaanooga,TN374061097 Return this Application as (Chattanooga State Community College)

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BROWSE CHATTANOOGA STATE COMMUNITY COLLEGE FORMS

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ChangeofPersonal

Informaon

PleaseCheckApplicableBox(es): Student Employee

Name(pleaseprint):



Last First Middle

DateofBirth:/ / StudentID(ANumber):

I. ChangeofName:

CurrentNameon

File:

Last First Middle

NewLegalName:

Last First Middle

AllrequeststochangenamemustbeaccompaniedbyyoursignedSocialSecuritycardordocumentaonfromtheSocial

SecurityAdministraonverifyinglegalnameandSocialSecuritynumber.InternaonalstudentsmayusetheI‐94form.

II. ChangeofSocialSecurity

Number:

PreviousSocialSec

urityNumberonﬁle:

CurrentSocialSecurityNumber:

I. CorrecontoDateofBirt

Correctdateofbirth:

/ /

mm/dd/yyyy

PleaseReadCarefully

 YournameandSocialSecuritynumberatChaanoogaStatemustmatchyourlegalnameandSocialSecuritynumber.

AnydiscrepanciesinthisinformaonmayresultinforfeitureofFinancialAidorotherproblems.

 Bysigningthisformyouareassumingresponsibilityforanyconsequencesthatmayresultfromcha

ngingyournameor

SocialSecuritynumberonﬁle,andaredoingsowithnointenttodefra

udChaanoogaStateCommunityCollege.

 PleasekeepinmindthatchangingyournamewillalsoresultinanupdatedTigerIDandTigerMailaccount.

 Pleasewait7businessdaysaersubmingthecha

ngeofnamerequest.ThenclickontheTigerIDWizardonthe

TigerWebhomepa

ge.EnteryourAnumber.YouwillthenseeyournewTigerIDandbeabletoresetyour

password.

 TolocateyournewTigerMailaddress,loginTigerWebandclick“ClickHereToEnter.”Gototh

ePersonalInformaon

tab,andthen“ViewEmailAddresses.”

 Ifyouhavepro

blemsaccessingyouraccount,pleaseemailStudentTechSupport@chaanoogastate.edu

StudentSignature: Date:

AllrequeststochangeSocialSecurityNumbermustbeaccompaniedbyyoursignedSocialSecuritycard.

StudentAﬀairs—Admissions/Records/EnrollmentServices

4501AmnicolaHwy.,Chaanooga,TN37406‐1097

Phone:423‐697‐4401

Return this Application as an attachment to submit@chattanoogastate.edu

Allrequeststocorrectyourdateofbirthmustbeaccompaniedbyyourstatedriverlicense,birth

cerﬁcate,orpassportverifyingthecorrectdateofbirth.

Pub. No. 11-70-501001-605-6/15/bap /form11• PDF • Chattanooga State Community College does not discriminate against students, employees, or applicants for admission or employment on the basis of race, color, religion, creed,

national origin, sex, sexual orientation, gender identity/expression, disability, age, status as a protected veteran, genetic information, or any other legally protected class with respect to all employment, programs and activities sponsored

by Chattanooga State. The following person has been designated to handle inquiries regarding the non-discrimination policies: Director and Affirmative Action Officer, 4501 Amnicola Highway, Chattanooga, TN 37406, 423-697-4457.

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