Fillable Records-change-form-fillable Records Change Form

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Records-change-form-fillable Records Change Form

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Country of origin: US
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Date:
OFFICE OF ADMISSIONS AND REGISTRATION
RECORDS CHANGE FORM
Empl ID#:
1. Name Change
From:
Last First Middle
To:
Last First Middle
2. Social Security Number Change
From: To:
3. Date of Birth Change (MM/DD/YY) 4. Gender Change
5. Immigration Status Change
From:
To:
o US Citizens
o US Citizens
o Permanent/Temporary Resident
o Permanent/Temporary Residents
o Parolee/Refugee/Asylee
o Parolee/Refugee/Asylee
o VISA
o VISA
o Other
o Other
I authorize the above changes:
Student Signature
FOR OFFICE USE ONLY
Date:
Gov/state picture ID and additional documentation may be required A&R Form – Rev 6/18
Received by:
Date:
Processed by:
Date:
From :
To :
From :
To :
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OFFICE OF ADMISSIONS AND REGISTRATION
RECORDS CHANGE FORM
REQUIRED DOCUMENTATION
No single document shall be conclusive and all documentation is subject to verification.
1.
Name Change
Gov/state picture ID (name on the picture ID must match all other documents) and
one of the following documents.
a.
Marriage License
b.
Divorce Final Judgment
c.
Naturalization
d.
Court Order
e.
Birth Certificate
f.
U.S. Passport
2.
Social Security Number Change
Government/state picture ID (name on the picture ID must match all other
documents) and original Social Security Card signed by the holder (if 18 years
and older).
3.
Date of Birth
Government/state picture ID (name on the picture ID must match all other
documents) and one of the following documents.
a.
Birth Certificate
b.
Naturalization Certificate or valid US passport.
4.
Gender Change
a.
Government/state picture ID (name on the picture ID must match all other
documents) and court order.
5.
Immigration Status Change
a.
Gov/state picture ID (name on the picture ID must match all other documents)
and immigration documentation.
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Records-change-form-fillable Records Change Form

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Completed 2 July 2020

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