Registrar
CHANGE OF SS#, NAME, DATE OF BIRTH APPLICATION
Please note the following:
All change of social security number (ID number) requires a signed original Social Security
Card. A copy will be made by college officials.
Student must submit original proof of birth date to change incorrect date of birth. A copy
will be made by college officials.
All name changes must be accompanied by the original supporting documentation (i.e.
marriage license, court order, divorce decree, birth certificate). A copy will be made by
college officials.
All documents submitted becomes legal property of the college and may not be surrendered
back and/or copied.
Change of Address and Telephone number must be completed on the John Jay website at Jay Stop.
Completed By Student
Please check the box(es) to indicate which of the following you are changing:
Check box(es)
Information in College Record
Change to New/Correct Information
below
□
Social
________-______-____________
________-______-____________
Security #
Social Security # (Student ID #)
Social Security # (Student ID #)
(document
needed)
□
___________________________
___________________________
Name
Last Name
Last Name
(document
needed)
________________
_________
__________________
_________
First Name
Initial
First Name
Initial
□
Incorrect
_______________
__________
_______________
__________
Date of
Month
Day
Month
Day
Birth
(document
______________
______________
needed)
Year
Year
If you receive financial aid, the above information will be changed for the College’s
financial aid database. If you qualify for financial aid disbursements, your financial
aid disbursements may be delayed depending on the time the above information is
processed.
Student Name: ____________________________________
Current Student ID#: _______________________________
Student Signature (required): __________________________
Date: _____________
For Office Use Only
Fall _____
Winter _____
Spring _____
Summer _____
Rec’d By: _________________________
SIMS Input Date: ___________________
White – Registrar
Yellow – Financial Aid
Pink – Student
8/13/2012