Request for Social Security Number
All students with a Social Security hold on their account must complete this form. It must be signed and submitted by the student in person; it cannot be faxed or emailed.The
Admissions Ofﬁce is located in SSC L156.
Manchester Community College requests your Social Security Number in order to
facilitate your application for ﬁnancial aid, to establish your eligibility for federal
income tax beneﬁts related to education expenses, to provide some services, to
enable the college to uniquely identify your records and to comply with federal
law requiring the college to demonstrate that it has requested your Social Security
Number for tax reporting purposes. The college is dedicated to ensuring the
confidentiality of students’ records and application materials.
Providing your Social Security Number is voluntary. A decision not to provide
a Social Security Number will not affect your admission to the College.
However, if you are applying for financial aid or you seek the benefits of a
federal income tax deduction and/or credit related to your education expenses,
you are required by the federal government (Internal Revenue Code and its
implementing regulations) to provide your Social Security Number. In addition,
some college services, such as use of the National Student Clearinghouse
pertaining to transcript requests and other services, require the use of your
Social Security Number.
Note: International students, including Canadian citizens, should leave “Social
Security Number” blank. An applicant identiﬁcation will be assigned to you.
Student First Name
I choose the following by placing my initials in the appropriate space to the left.
MI Last Name Banner ID Number
I will provide my Social Security Number.
Social Security Number
I decline to provide a Social Security Number.
I do not have a Social Security Number to provide.
By signing this document I acknowledge that I have read and understand the above information.
Student Signature Date
The Federal Privacy Act (5. U.S.C. 552a(e)(3)) provides that each agency that maintains a system of records shall inform each individual whom it asks to supply information
on the form which it uses to collect the information or on a separate form that can be retained by the individual, (A) the authority granted by statute or by Executive Order
which authorizes the solicitation of the information and whether disclosure of such information is mandatory or voluntary; (B) the principal purpose or purposes for which
the information is intended to be used; (C) the routine uses which may be made of the information; and (D) the effects the person, if any, of not providing all or any part
of the requested information.
Date Received _______/_______/__________ Reviewed By ______________________________