Metropolitan State University Name Or Social Security Number Change
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1Name or Social Security Number
Gateway Student Services
Change
700 East Seventh Street
Saint Paul, Minnesota 55106-5000
E-mail: gateway@metrostate.edu
Phone: 651-793-1300
Who needs to use this form?
Important Notes
How to Submit
Current and former students who wish
• If you are an active student, you will need
All students must complete sections 1 and 4.
to declare a legal name or social security
a new student account. IT will
Complete section 2 for a name change, and
be contacted on your behalf, and they
number change.
section 3 for a social security number change.
will follow up with you.
Submit this form, along with legal
• Metropolitan State University reserves
documentation, to the Gateway Student
the right to request more than one
Services Center by mail or in-person.
form of documentation for verification
purposes.
Section 1 - Current Student Information
Print current name: _______________________________________ _______________________________________ ____________________
Last
First
Middle
Metropolitan State student ID: ___ ___ ___ ___ ___ ___ ___ ___
E-mail address: ___________________@_________________________
If you are a current student of Metropolitan State, use your student e-mail address
Phone (with area code): ______-______-_____________
Birth Date: _____ / _____ / _______
MM
DD
YYYY
Are you a U.S. citizen?
o Yes o No
I
: type of visa: o F1 o Other ________
f no
Staff: Check with International Student Services
Section 2 - Name Change
Select one:
q Change display name only; display name changes will impact the name you and/or others see via the portal, D2L, email, class rosters, and official
records.
q Change username and display name; username changes will impact how you log into the portal, D2L, and email along with changing the name you
and/or others see via the portal, D2L, email, class rosters, and official records.
q Make no technology changes; everything will remain as is except for the impact to official records.
Effective date: ____ / ____ / ______
q I have included a copy of legal documentation of this change.
MM
DD
YYYY
Examples include: birth certificate, marriage license, court order, naturalization document, divorce
decree (please include only pages indicating name change).
Print new name: __________________________________________ _______________________________________ ____________________
Last
First
Middle
Section 3 - Social Security Number Change
Effective date: ____ / ____ / ______
q I have included copies of my new social security card and a photo ID.
MM
DD
YYYY
New social security number: ___ ___ ___ - ___ ___ - ___ ___ ___ ___
Section 4 - Signature
I request and authorize Metropolitan State University to change my university record using the included legal documentation.
Signature: ______________________________________________________________________________________ Date: ____ / ____ / ______
MM
DD
YYYY
An equal opportunity educator and employer
Last updated 04/2012
Member of the Minnesota State Colleges & Universities (MnSCU) system
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Parent category: Legal