Fillable Name Change Or Social Security Number Form printable pdf download

Name Change Or Social Security Number Form

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Kekaulike Information and Service Center (KISC)

4303 Diamond Head Road, ‘Ilima 102  Honolulu, HI 96816-4421

Phone: (808) 734-9555  Fax: (808) 734-9896  Email: kapinfo@hawaii.edu

NAME CHANGE or SOCIAL SECURITY NUMBER FORM

Complete this form with the required documentation attached and return to the address above. Forms without

appropriate documentation attached will not be processed. Students changing their names after the semester

begins should inform their instructors of their name change. Please type or print clearly.

Current Name on Record: ________________________________________________________

Last

First

Middle

UH Number: _______________________

Daytime Phone/Cell: ________________________

UH Email Address: _____________________________________@hawaii.edu

 SUBMIT SOCIAL SECURITY NUMBER (for Admissions): _________ - _________ - _________

 CHANGE SOCIAL SECURITY NUMBER. Attach a copy of your Social Security Card.

From: _________ - _________ - _________

To:

_________ - _________ - _________

 CHANGE NAME to: ____________________________________________________________

Last

First

Middle

CHECK ONE and PROVIDE THE APPROPRIATE DOCUMENTATION:

 Correct error in spelling

(Birth certificate, State ID, US Military ID, Passport, U.S. Resident Alien Card)

 Change due to marriage

(Marriage certificate)

 Change due to divorce

(Divorce decree)

 Legal Change of Name

(Court Petition for Name Change, U.S. Naturalization Certificate)

STUDENT’S SIGNATURE __________________________________________ DATE ___________

OFFICE USE ONLY

Banner ID: _____________________

Completed By/Date: ___________

Notified: VA FA HIC UH-ITS

Folder Changed By/Date: ________

Student Type: Currently Enrolled Returning First Time New/Transfer

Rev. February 2012

Name Change Or Social Security Number Form

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