Registrar Name SSN ChangeForm

Student Services Center Natchitoches, LA 71497 T 318.357.6171 800.807.8849 F 318.357.5823 [email protected] OFFICE OF...

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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 ______________________________