Office of the Registrar
DuBourg Hall, Rm. 22
221 N. Grand Blvd
St. Louis, MO 63103
Phone: (314) 977 2269
Fax: (314) 977 3447
E-Mail: registrar@slu.edu
Personal Information
Update Form
Please Print to Ensure Accurate Entry
Current Identifying Information
Name:
(Last Name, First, Middle)
SLU ID # __ __ __ __ __ __ __ __ __ Date of Birth __ __ / __ __ / __ __ __ __
(9 digit number on ID Card) (Month, Day, Year)
Change of Name
Please provide proof of the name change; Marriage License, State Issued ID, SSN Card, or Other Legal Document
New / Corrected Name:
(Last Name, First, Middle)
Salutation: Previous: New / Corrected:
(Miss, Mrs., Etc)
Change / Correction of Biographical Information
Check the Appropriate Box Adjacent to the Designations in Each Area
Signature: Date:
Citizenship: Gender:
US Citizen
Non-US Citizen
Female
Male
Ethnicity:
African American / Non-Hispanic
American Indian / Alaska Native
Asian / Pacific Islander
Hispanic White
Prefer Not to Respond
Other:
Religious Affiliation:
Baptist
Episcopal
Jewish
Lutheran
Methodist
Muslim / Islamic
Presbyterian
Roman Catholic
Other Protestant
No Preference
Other:
Change / Correction of Social Security Number / Date of Birth
Please provide copy of SSN card or Birth Certificate
Social Security # __ __ __ - __ __ - __ __ __ __ Date of Birth __ __ / __ __ / __ __ __ __
(Month, Day, Year)
Marital Status
Seperated
Single
Widowed
Divorced
Life Partnered
Married
Prefer Not to Respond
Required
Change
Change
Change
Please Provide Documentation
