Name & Social Security Number Change Form
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1Student Services Center
Natchitoches, LA 71497
T 318.357.6171
OFFICE OF THE REGISTRAR
800.807.8849
F 318.357.5823
registrar@nsula.edu
Name & Social Security Number Change Form
Name Change
Please check one of the following:
Student ________
Employee of the University______
Current Name
_______________________________________________________________________
Last
First
Middle
Other
SSN or Banner ID
_______________________________________________________________________
Change Name to
_______________________________________________________________________
Last
First
Middle
Note: Your social security card reflecting your new name and a clear picture ID must be submitted
in support of an official name change.
______________________________________________
_________________________
Student’s Signature
Date
Social Security Number Change
Please check one of the following:
Student ________
Employee of the University_______
Name _____________________________________________________________________________________
Last
First
Middle
Incorrect Social Security Number
______________-__________-____________________
Change Social Security Number to
______________-__________-____________________
Note: Your social security card and a clear picture ID must be submitted for all SSN changes.
______________________________________________
_________________________
Student’s Signature
Date
Official Use Only
DO NOT WRITE IN THIS SPACE.
c Social Security Card
c Driver’s License
c NSU One Card ID
Original document copied by __________________________________________________________________
Date Processed __________________________
Processed By ______________________________
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