Official Data Update Form
Name: _______________________________________________________________________________________
First Middle Last
Student ID: Date of Birth: ________________________________
Student Signature: Date: ____________________
Notes: Students should update their Demographic Data (Address Change) in their Student Service
Student Workers must submit changes to Gateway’s Human Resource Dept.
Change From
Change To
Primary Name *
(legal name)
Preferred Name
Address (include city, state, zip)
Primary Phone Number
Social Security Number +
(Requires Photo ID & documentation)
Date of Birth **
(Requires Photo ID and documentation)
Submit the following documentation with this Form:
* Name Change copy of Marriage Certificate, Court Documentation or a valid Driver’s License / State ID
** Date of Birth Change - valid Driver’s License / State ID for Date of Birth Verification or Birth Certificate
+ Social Security Change - copies of the Original Social Security Card and valid Driver’s License/State ID
For office use- Updated by: ____________ date: ________________ 6/2020
click to sign
click to edit