SOCIAL SECURITY NUMBER CHANGE REQUEST
Student Status:
Applicant Current Former
NOTE: YOU MUST PRESENT YOUR SOCIAL SECURITY CARD WHEN CHANGING YOUR SOCIAL SECURITY NUMBER.
Please bring original documents to the Admissions Office to be copied. Copies will not be accepted.
Enter Social Security Number and name as they appear on current file:
SS #:
(No dashes or dots)
Last Name: First Name: Middle Initial:
Phone #: Email:
Enter new/correct Social Security number below:
New SS #:
(No dashes or dots)
Student Authorization:
I acknowledge that entering my name on this form is the equivalent of my signature. By submitting it I
authorize the Georgia Piedmont Technical College Admissions Office to process my request.
Student Name: Date:
Georgia Piedmont Technical College does not discriminate on the basis of race, color, creed, national or ethnic origin, gender, religion, disability, age, political affiliation or
belief, disabled veteran, veteran of the Vietnam Era, or citizenship status (except in those special circumstances permitted or mandated by law).
NOTE: Processing cannot be guaranteed unless forms are sent from GPTC student email accounts.
Admissions Office Use Only Request completed: Initials:
