Revised: 7/14/2016
OFFICE OF THE REGISTRAR
MSC 105, 1050 W SANTA GERTRUDIS AVE
KINGSVILLE, TEXAS 78363-8202
PH (361) 593-2811 * FAX (361) 593-2195
www.tamuk.edu
REQUEST FOR CHANGE OF STUDENT PERSONAL DATA
Note: Only complete the area(s) that you will be updating. (Blue or Black ink only)
Student ID or SS#:______________________ Name:__________________________________
(as currently listed on TAMUK records)
Name Change (original or notarized certified copy of birth certificate, marriage certificate, divorce decree, passport or court order required for change)
Previous Name: (as listed on TAMUK records)____________________________________________________________________________
First Middle Last (Maiden)
New Name:________________________________________________________________________________
First Middle Last
Social Security Number Change (original or notarized certified copy of social security card required for change)
Incorrect/Current Number: ______________________ Correct/New Number: __________________________
Date of Birth Change (original or notarized certified copy of birth certificate or passport required for change)
Incorrect/Current Date of Birth___________________ Correct/New Date of Birth_______________________
Address Change
Street Line 1:_______________________________________________________________________________
Street Line 2: ______________________________________________________________________________
City, State, Zip Code: ________________________________________________________________________
Indicate all that apply: Permanent Mailing/Local Billing
Telephone Number Change
Phone: ( )________________________ Indicate all that apply: Permanent Cellular Work Other
E-Mail Address Change (Note: while we will maintain personal email addresses, a university email address is required)
Email Address:_____________________________________________________________________________
Student’s Signature:_________________________________________ Date:__________________
For Office Use Only Date: _____________________ Processed by:____________________
