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Password Reset Request Form
Use this form to have your Password reset or to obtain your Username. Requests for Username
will be sent in a separate communication for security purposes.
You may scan and email this request to your campus Registrar Office, as shown below.
Select Only One email address:
Ammerman: registrara@sunysuffolk.edu
Eastern: registrare@sunysuffolk.edu
Michael J. Grant: registrarw@sunysuffolk.edu
Please provide the following information:
Date:
First Name:
Last Name (while attending):
ID number or last four digits
of SSN:
Date of Birth (month/day only):
Current phone number:
Email address (Not your SCCC
Email) to forward temporary
password reset:
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___ I give permission to the Registrar Office to reset my password.
___ I request the Registrar Office provide my Username.
Once you receive your temporary password, you will need to enter a permanent password. You
can do this on MySCCC by selecting Change my Password.
If you are sending this request from an email address other than your SCCC email, you must
include a copy of your Driver License for the purpose of authentication and signature
comparison.
Student Signature:
(revised: 4/21/20)
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