Social Security Number Request Form - College Of Charleston printable pdf download

Social Security Number Request Form - College Of Charleston

Social Security Administration

1463 Tobias Gadson Blvd.

Charleston, SC 29407

STUDENT SOCIAL SECURITY NUMBER REQUEST

To Social Security Administration:

This is evidence of employment for:

________________________________________________________________________

(Name- Student)

Nature of student’s job (e.g., wait staff, library aide, research assistant, etc.):

________________________________________________________________________

Start Date:

__________________

Number of Hours/Week:

___________

Employer contact information:

College of Charleston

___________________________________

(Student’s Immediate Supervisor)

____________________________________

(Supervisor’s Telephone Number)

_______________________________

___________________________________

Supervisor’s Signature (Original)

Supervisor’s Title

Date: _____________________________

FOR CIE USE ONLY:

I certify that this student is enrolled as a full time student at College of Charleston and has

a position of employment. Please issue this student a social security number.

_____________________________

___________________________

CofC Designated School Official

Typed or printed name

(DSO/ARO) /Responsible Officer – Original Signature

_____________________________

Date

66 GEORGE ST. |CHARLESTON, SC 29424-0001

Social Security Number Request Form - College Of Charleston