Name Changed: _________ SSN Changed: __________
DOB Changed: __________ No Change: ___________
Processed By: ___________________________________
1/31/2018
Office of the
University Registrar
1 Ohio University
Chubb Hall
Athens OH 45701-2979
Fax 740.593.0216
Legal Name:
PID:
PERSONAL DATA VALIDATION FORM
By submitting this form, I am validating with Ohio University my personal data—legal name,
date of birth, and Social Security number—via the following documentation (either show in
person or provide a copy):
•
Valid driver's license and Social Security card (you must submit both) or
•
Federal or state issued identification card and a Social Security card (you must submit
both) or
•
Valid passport and a copy of your Social Security card (you must submit both)
Submit this completed form and documentation:
•
in person at the Office of the University Registrar, Chubb Hall, or any regional campus
student services office
•
via fax to 740.593.0216
•
via U.S. mail or your preferred carrier to Office of the University Registrar, Chubb Hall,
Ohio University, Athens, OH 45701
I hereby authorize Ohio University to update this information, as appropriate, based on the
included documentation.
Signature: Date:
Student: Do not write below this line.
click to sign
signature
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