Request for Student’s Taxpayer Identification Number
(Substitute Form W-9S)
Do not submit this form to the IRS.
Please return completed signed form, in person or by mail, to:
Pitzer College Student Accounts Office
McConnell Center 320
1050 North Mills Avenue
Claremont, CA 91711
PART I
Name of Student: _______________________________________________________
Address: _____________________________________________________________
Taxpayer Identification Number (SSN or ITIN): __ __ __ - __ __ - __ __ __ __
PART II
I certify that the number shown on this form is my correct taxpayer identification number.
____________________________________________ ________________
Signature Date
OR
PART III
□ I am a foreign national/nonresident alien and do not have a Social Security number or individual taxpayer
identification number. I do not plan to file an income tax return in the U.S.
□ I do not wish to provide my taxpayer identification number to Pitzer College at this time. I understand that I
may be subject to an IRS fine of $50 for failure to do so. I further understand that the IRS will not be able to use
the Form 1098-T filed by Pitzer College to confirm my eligibility for certain education tax benefits without my
taxpayer identification number.
____________________________________________ ________________
Signature Date
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