Fillable Office of the Registrar Laffin Hall Room 225 (State University of New York at Farmingdale)

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Office of the Registrar Laffin Hall Room 225 (State University of New York at Farmingdale)

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Office of the Registrar
Laffin Hall Room 225
2350 Broadhollow Road
Farmingdale, NY 11735
Student Information Change Form
Complete the box below as it currently appears on our records. Please print clearly
Last Name:
First Name:
Middle:
RAM ID or Last 4 of SSN:
Date of Birth:
Change of Mailing Address
FROM
TO
Street:
Street:
City:
City:
State:
State:
Zip code:
Zip code:
Phone:
Phone:
Change of Name
Please write your name below as it should now appear on your records
Requires one form of documentation: Marriage Cert, Divorce Decree or Court Order Including Both Names
Last Name:
Middle:
Change of Date of Birth
Requires one form of documentation: Birth Certificate, US Issued Drivers’ License/ID or Passport
From:
To:
Change of Social Security Number
Requires documentation: Social Security Card
From:
To:
Change of Gender
Requires one form of documentation: Pre or post-operative documentation from qualified health care provider,
letter of support from a qualified mental health professional, birth certificate or court order legalizing preferred
gender, or valid driver’s license or passport reflecting the gender identity.
From:
To:
I hereby confirm the above information to be accurate. I understand without providing the proper
documentation the requested change cannot be processed. All forms of documentation must be valid original
documents or certified copies.
Signature:_____________________________________ Date:_____________________________________
regoffice@farmingdale.edu
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Office of the Registrar Laffin Hall Room 225 (State University of New York at Farmingdale)

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Completed 1 October 2020

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