Verifi cation of
Social Security Number
Financial Aid Services
& Date of Birth
2016-2017
The University of Massachusetts requires that you submit a copy of the documentation verifying your Social Security number and date of
birth. This ensures the protection of your record. It is understood that this change is made without any intent to defraud the University
or those persons/institutions who might request a copy of your record.
Be Advised: If you receive fi nancial aid you must update all of your fi nancial aid records including your FAFSA form and your Social Security
Administration record to be consistent with this information. In order to comply with federal regulations and continue processing your
fi nancial aid for the 2016-2017 academic year, it is necessary to verify this information. Failure to do so will result in the cancellation of any
fi nancial aid that you currently have and/or halt any further processing.
Information should be submitted to:
Financial Aid Services, 243 Whitmore Administration Building, Amherst, MA 01003
A. STUDENT INFORMATION
(Please print legibly)
SPIRE ID#: ____________________
Name: ______________________________________________
Last Name
First Name
Middle Initial
My correct date of birth is: ________/__________/________________
MM
DD
YYYY
My correct Social Security number is: ________ - _____ - _________
B. SIGNATURE
_________________________________________
________________________
Student Signature
Date
C. REQUIRED DOCUMENTS TO SUBMIT
A
copy of one of these documents must accompany this completed form:
• Birth certifi cate, passport, or driver’s license - For correction to date of birth.
• Signed Social Security card - For corrections to Social Security number.
D. FOR OFFICE USE ONLY
SSN/DOB as it appeared prior to change: _____-_____-_______ _____/_____/_______
Copy received: ____________
Initials: __________________
Date: ___________________