Revised: January 2020 Office of Records & Registration
STUDENT INFORMATION CHANGE REQUEST
Submit completed form to the Records Office via email at records@ggu.edu, via fax to (415) 442-7223,
or in-person or via mail to: Golden Gate University, Office of Records and Registration, 536 Mission
Street, San Francisco, CA 94105-2968. Note: if changing your legal name, a new @myggu.edu email
address will be automatically system-generated. To have your email messages from your old address
mailbox forwarded to your new address, contact the Help Desk at help@ggu.edu for assistance.
CURRENT INFORMATION IN GGU RECORDS:
GGU ID Number or SSN: __________________
Name: _______________________________________ _________________________________
last (family) name first (given) name
New INFORMATION:
Social Security Number: __________________________________ Birth Date: _________________
Title (check one): ❑ Ms. ❑ Miss ❑ Mrs. ❑ Mr. ❑ Dr. ❑ Other _____________________________
Legal Name: _______________________________________________________________________
last (family) name first (given) name middle name or initial
Name change requests must include proof of new name, such as a marriage certificate, court order, etc.
Home Address: _____________________________________________________________________
street
__________________________________________________________________________________
city state zip country
Work Address: ______________________________________________________________________
street
__________________________________________________________________________________
city state zip country
Telephone: Home: ___________________________ Business: _____________________________
Cellular: ________________________________ Fax: ____________________________________
Email Address: _____________________________________________________________________
Emergency Contact: _______________________________ _______________________________
Name relationship
Emergency Contact Phone: ________________________________
Date Change Becomes Effective: ________ Signature: ______________________ Date: _________
Date Received: _______________ Changed By: _____________________________ Date Changed: ____________
click to sign
signature
click to edit
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