Rev. 7/25/18
UPDATE CITIZENSHIP, DOB, SSN/ITIN
A current student may update citizenship, date of birth and SSN/ITIN by completing this form.
Name: _______________________________________________________________________________________
(Last name) (First name) (Middle name)
Email Address: ____________________________ Mobile Telephone: ___________________________
Program of Study: _____________________________
Check which of the following you wish to update:
________ Citizenship
In order to update citizenship, at least one document from each category in the following list must be
submitted with this form. The documents must include the current legal name.
Category 1 Category 2
Certificate of Citizenship Driver’s License
Naturalization Certificate Government Issued Photo ID
U.S. Passport MCW ID
________ Date of Birth
In order to update date of birth, at least one document from each category in the following list must be
submitted with this form. The documents must include the current legal name.
Category 1 Category 2
Birth Certificate Driver’s License
U.S. Passport Government Issued Photo ID
MCW ID
________ SSN/ITIN
In order to update SSN or ITIN, at least one document from each category in the following list must be
submitted with this form. The documents must include the current legal name.
Category 1 Category 2
SSN Card Driver’s License
ITIN Card Government Issued Photo ID
MCW ID
I verify the submitted documents are true and correct copies of the original documents.
Signature: _________________________________________________ Date: ___________________
Return this signed form to: or Return this form by emailing a PDF of the signed form to acadreg@mcw.edu.
Medical College of Wisconsin
Office of the Registrar, M3200
8701 Watertown Plank Road
Milwaukee, Wisconsin 53226
(414) 955-8733
