Student Record Data Change Form
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1Student Record Data Change Form
UWM Registrar’s Office
Instructions: Use this form to make corrections to your Social Security number, name or date of birth, gender, race/ethnicity. We
require supporting documentation to process Social Security Number, name, birth date, and gender changes.
Gender Change
Action Requested:
Name Change
Social Security Number Change
Name Correction
Birth Date Change
Race/Ethnicity Change
New/Correct Information:
Name
Previous or Incorrect Name
Student Number
Correct Social Security Number
Correct Gender to Male
Correct Gender to Female
Birth Date
Race/Ethnicity:
Please answer both a and b.
a. Ethnicity: Are you of Hispanic or Latino/a origin?
Yes
No
(If yes, choose one or more from the following list.)
Cuban
Puerto Rican
Mexican, Mexican American or Chicano/a
Other Hispanic or Latino/a
b. Race: Choose one or more from the list below.
African American or Black
Native Hawaiian/Pacific Islander
Laotian
Cambodian
American Indian or Alaska Native
Vietnamese
(specify tribal affiliation)
Hmong
Other Asian
White
Your signature is required to process all changes:
I request that the change(s) indicated above be made to my University record. I understand that the changes are effective as of
the date this form is received in the Registrar’s Office.
Date: ______________________________
Signature: _______________________________________
FOR RO USE ONLY
Received by: _________________________
Date: ________________________________
UGRD
GRAD
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