Name, Address, Phone, E-Mail, Ssn Change Form printable pdf download

Name, Address, Phone, E-Mail, Ssn Change Form

Registration & Records

Location: 5115 Oak Street, 115

5100 Rockhill Road

Administrative Center

Kansas City, MO 64110-2499

Phone: 816-235-1213

Fax: 816-235-5513

Name, Address, Phone, E-mail, SSN Change Form

Print this form, complete the appropriate section(s) below, sign the form at the bottom, and mail, fax, or deliver

this form to the Registration & Records Office. Use this form to correct or update student information contained

in your official record. Identification is required for social security number and name changes. The student is the

only person authorized to change name, address, phone, e-mail and SSN information.

•

Complete this section only if your name has changed.

*Documentation required.

Old Name:

New name:

•

Complete this section only if your address or phone number has changed.

Street:

City, State, Zip:

This is my

(check all that apply)

Local Address

(where you live during the term)

Permanent Address

(parents address or an address that is relatively unchanging)

Billing Address

(where you want your bill mailed)

Diploma Address

(where you want your diploma mailed)

•

Complete this section only if your phone number has changed.

New Phone Number:

This is my

(check all that apply):

Local Phone

Permanent Phone

Mobile Phone

Complete this section only if your personal e-mail address has changed.

•

NOTE: Your UMKC e-mail address will still be used for all official communication from UMKC.

New non-UMKC E-mail address:

•

Complete this section only if your social security number has changed

NOTE: If you receive financial aid, your correct social security number must be maintained by the university to be in

compliance with federal law. *Documentation required.

Social Security Number:

____________

Signature:

Date:

Printed Name:

Student number:

*Acceptable forms of documentation include a current driver’s license or an original social security card.

Processed by:

Date:

Name, Address, Phone, E-Mail, Ssn Change Form

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