Check here if number is for hard copy only—
not to be entered into banner
Name: _____________________________________________________________ Date of Birth _____/_____/_________
Last First Middle Month Day Year
Student Cell
Employee ID#: _______________________________ Home Phone Number (______)______-________
Vendor Work
Email: ________________________________________ Alt. Email: _______________________________
NAME CHANGE Requires current social security card (employees only).
Permanent Address PR
Mailing Address MA
Update at www.UAOnline.alaska.edu, no form required.
Employee Related Address HR
Will affect mailing of pay statement and W-2.
New Address: ______________________________________________________
______________________________________________________
City: ___________________ State: _____________ Zip: ___________________
County: _________________________ Province: _________________________
check all that apply
New Phone home cell work
(____
__) __________-______________
New Phone home cell work
(_______) __________-_____________
Former Name: _________________________________________________________________________________________
Last First Middle
Current Name*:_________________________________________________________________________________________
Last First Middle
*Your current name must appear on any documents that you submit in support of your request.
Correct SSN: _________-______________-____________ Incorrect SSN: _________-______________-____________
Your Social Security Number (SSN) is required for tax, employment and federal financial aid purposes. All information including your SSN, will be kept confidential and secure as outlined by state
and federal laws. An assigned number is used for University records; however, a portion or all of the SSN may be used for identity verification by systems and software application.
University of Alaska
REQUEST FOR CHANGE
Address, Name, Marital Status, SSN
CHECK GUASYST: Student Fin Aid Employee Finance A/R OFFICE USE ONLY
Processing: Student __________ International __________ HR __________
Forward to: IT HR International Registration Finance
SPACMNT: Date Rec’d:__________________
I request the above change(s) be made in official University records in accordance with University policy and this form.
x_____________________________________________________________________________ __________________________
Signature Date
In order to make changes listed below to your official student record, we will need a copy of one of the following items:
Driver’s License Passport Permanent Resident Card
Social Security Card (required for SSN changes or if you are a past/present university employee)
ADDRESS CHANGE Check each address you want to change.
SOCIAL SECURITY NUMBER CORRECTION Requires current social security card.
MARITAL STATUS CHANGE
Single
Married Divorced Separated Widowed
check all
that apply
I am now:
MAU/Major Administrative Unit (circle one)
UAA UAF UAS SW
Department
Foreign Permanent Address SF
U.S. Physical Address SU
For F or J Visa holder only
