Student Services Center Natchitoches, LA 71497 T 318.357.6171 800.807.8849 F 318.357.5823
[email protected]
OFFICE OF THE REGISTRAR Name & Social Security Number Change Form Name Change Please check one of the following:
Student ________
Employee of the University______
Current Name
_______________________________________________________________________
SSN or Banner ID
_______________________________________________________________________
Change Name to
_______________________________________________________________________
Last
Last
First
Middle
First
Other
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 ______________________________