Social Security/name/date Of Birth Change Form printable pdf download

Social Security/name/date Of Birth Change Form

SOCIAL SECURITY/NAME/DATE OF BIRTH CHANGE FORM

(FOR CURRENTLY ENROLLED STUDENTS ONLY)

NAME: _______________________________________________SUid: (required)

Please complete ONLY those items which require changing and return to the Office of the Registrar.

Name Changes: Please include your first, middle and last names below. Documentation is required for name

changes. Please submit a copy of your signed social security card.

Previous Name:

New Name:

Type of documentation submitted for change:

Reason for change:

Date of Birth Changes: Documentation is required for date of birth changes. Please submit a copy of your birth

certificate. For questions regarding your date of birth, contact SSA at 800-772-1213 or visit their website at

Date of Birth:

Type of documentation submitted for change:

Reason for change:

Social Security Number Changes: Documentation is required for social security changes. Please submit a copy of

your signed social security card. For questions regarding your social security number, contact SSA at 800-772-

1213 or visit their website at

Old Social Security Number:

New Social Security Number:

Type of documentation submitted for change:

Reason for change:

Student signature: ____________________________________________________Date signed:

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Office of the Registrar Use Only:

Change completed by: ___________________________________________Date completed:

Documentation submitted:

Copies sent to Payroll:

Date:

Samford University

Office of the Registrar

800 Lakeshore Drive

Birmingham, AL 35229

Phone Number (205)726-2911 / email: registrar@samford.edu

Social Security/name/date Of Birth Change Form