Revised 4/21/2017
Student Data Change Form
This change form is used for changes or corrections to your name, social security number, date of birth,
permanent address, or major.
INFORMATION CURRENTLY ON RECORD:
UH Student ID Number or MyUH Username:
Current Name on file:
(LAST), (FIRST), (MIDDLE)
Are you currently enrolled at Leeward Community College?
YES
NO
Signature of VA certifying official:
Date:
ITEMS TO BE CHANGED OR CORRECTED
Check and complete changes that apply. Attach required documents (*), refer to back for more information.
Social Security Number should be*: _________ - _________ - ___________
Birth Date should be*: _________ / _________ / ___________
(MM) (DD) (YYYY)
Legal Name should be*:
(LAST), (FIRST), (MIDDLE)
Preferred First Name:
(Please read information in the back before signing below)
Permanent Address:
(STREET) (APT/SUITE)
(CITY), (STATE) (ZIP CODE)
Major should be:
Degree/Certificate:
(Change of major effective beginning of the next term)
Signature:
Date:
Admissions and Records use only
Verified by:
Document Type:
Date Completed:
If not completed, reason:
Clear Form
Leeward Community College
Admissions and Records Office
POLICIES AND PROCEDURES GOVERNING STUDENT DATA CHANGES
1. Leeward CC policies and practices
a. Legal name changes which are supported by appropriate specified documentation will be accepted for
processing. Name changes will be noted on the Permanent Record Card (PRC) with the former name in
parenthesized for audit purposes (for students enrolled prior to Spring 1987 only). For currently enrolled
students, instructor’s class lists and grading rosters will reflect updated information.
b. Descriptive prefixes (e.g. Mr. Dr. Rev.), descriptive suffixes (e.g. Jr., II, III), nicknames and aliases are not
deemed to be part of a person’s legal name; unless such are made part of the legal name by which it is
supported by legal name changing documentation.
2. Listed below is the acceptable documentation for each type of data change request. (Attach photocopy or present
original documents together with this completed Student Data Change Form at the Leeward CC Admissions and
Records Office)
Documents provided must support the requested data change. For example, if you are using a
marriage certificate to document a name change, the marriage certificate must include your new
legal name in order to be a valid name change document.
a. Social Security Number
Social Security Card (SSC)
- When the SS# change is from one valid SS# to another
(excluding the 99-xx-xxxx SS# series), a Social Security Administration letter
must also be submitted to verify the new valid SS# of the student.
- If SS# change only involves 3 or less digits, or is the 900-xx-xxxx ID# changes
to a valid SS#, presentation of SS card is sufficient.
b. Birth Date Change
Birth Certificate (BC)
Passport (PP)
c. Name Change
To Correct error in spelling (attach Birth Certificate, U.S. Military ID, Passport, U.S. Resident Alien
Card, State ID Card, or Social Security Card)
Change due to marriage (attach Marriage Certificate)
Change due to divorce (attach Divorce decree)
Legal Name Change (attach Court Petition or U.S. Naturalization Certificate)
d. Preferred First Name
By signing this document, I understand and agree to the following:
Refer to EP 7.302 Preferred Name Policy to support student who have a preferred name, such as Hawaiian
name, an international name or a name that is concurrent with their gender identity. This policy is limited to
first name and not surname or family name. UH will make every effort to display preferred first name to the
University community where feasible and appropriate and make a good faith effort to update reports,
documents and systems. Preferred name will appear on UH ID card, class roster and directories such as
Laulima and STAR.
UH reserves the right to deny or remove, with or without notice, any preferred name for misuse, including but
not limited to fraud, misrepresentation, attempting to avoid legal obligation, or the use of highly offensive or
derogatory name.
Legal name will still be used on certain records, including official transcripts, diplomas, paychecks, payroll
records, enrollment verifications, medical records, financial aid documents, and other records, which require
use of an official name of record.
Special Characters are not possible at this time
Replacement fee charges may apply to issue new UH ID card
Submit a properly completed STUDENT DATA CHANGE FORM with the required documentation (if applicable) to the
Leeward CC Admissions and Records Office, AD-220.
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