Molloy College Student Information Sheet
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2MOLLOY COLLEGE
STUDENT INFORMATION SHEET
Social Security Number____________________________ Student ID Number If Known______________
Current Legal Name______________________________________________________________________
Last
First
Middle (required)
Suffix
New Legal Name**_______________________________________________________________________
Last
First
Middle (required)
Suffix
Maiden Name or Birth Name_________________________________ Date of Birth __________________
Address/Street_____________________________________________ County of Residence____________
City_______________________________________ State_________________ Zip__________________
Home Phone (_____)___________________________ Cell Phone (_____)__________________________
Non-Molloy E-Mail*_____________________________________________________________
*Due to FERPA policies, e-mail from the college will be sent to your Molloy g-mail account once your account is set-up. Self-
reported non-Molloy e-mail addresses are maintained as secondary records.
**Name change requests must include appropriate documentation, such as court orders, governmental documents or marriage
licenses. Please attach documents for name changes.
Biographical Information:
Citizen of:
________U.S. Citizen _______ Resident Alien __________ Non-Resident Alien
If not a U.S. Citizen, then what country are you a citizen of?______________________
Ethnic/Racial Origin (See backside for governmental descriptions):
Do you consider yourself to be Hispanic or Latino? (Yes or No?) ____________________
In addition, please select one or more of the following racial categories to describe yourself:
_______ American Indian or Alaska Native Non-Hispanic
_______ Asian
_______ Black or African American
_______ Native Hawaiian or Other Pacific Islander
_______ White
Marital Status (Please Check One): Married (M)_________
Single (S)_________
Sex (Please Check One):
Male (M) ___________
Female (F)________
Religious Preference (Please Check One):
Roman Catholic (R)___ Jewish (J)___ Muslim (M)___ Protestant (P)___ Other (O)___ None (N)___
Signature of Student (Required): __________________________________ Date: ____________________
For Registrar’s Office Use:
Updated By (Initials)_____ Data Entry Date _____ UG? _____ GR? _____ DO? _____
Revised 10/23/2015
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