Personal Data Change Request Form (Address, Telephone, Name, and Social Security Changes) 


IMPORTANT: Please print clearly. For Address Changes, Name Change and/or Social Security Number 
Changes, you must complete all information requested. Submit this form with supporting documentation 
to the address above. If you are changing your name or social security number and a currently enrolled
student, you must obtain a new student identification card. 

 

REQUIRED INFORMATION- PLEASE PRINT CLEARLY 

 

All information must be noted as it appears on the records of the College. 

 

Please circle all that apply: I am a: Current Student       Former Student         Alumni 


EMPLID (CUNYfirst ID) ________________________________


Social Security Number _______________________________      Date of Birth ________________

 

First Name: __________________________________________


Last First: __________________________________________


MI: ___________ 

 

Student’s Signature: ____________________________________________  Date: __________________
 




ADDRESS AND/OR TELEPHONE NUMBER CHANGE* 


Please circle all that apply*: Home       Mailing       Billing      Permanent      Telephone Number 

 

House Number/Street _____________________________________________  Area Code __________
 


City State Zip County ___________________________________________

 

Telephone Number __________________________________


*If this change of address is from another state to New York State, to qualify for in-state tuition a
student must also submit a completed residency request form with the appropriate documentation to
Admissions Office. If this change of address is from NY State to another state your tuition charges 
will be updated to reflect your out-of-state status. If you are a foreign student, on a visa, your
permanent residence must remain your home country. The student must also notify the College 
International Student Coordinator located on campus concerning any changes. 

 


NAME CHANGE/ CORRECTION 

 
CUNY requires LEGAL documentation for any change of name. Photocopies will not be accepted. 


Please attach two (2) types of appropriate documentation; one type of documentation must be either a 
marriage certificate, passport, birth certificate, social security card, divorce decree or a court
order, the second must be a Photo ID. Students must notify Social Security of any legal name change. 
You must obtain a new student identification card once processed. 

 
Complete New Name:   (Last)_________________________   (First) ______________________ (Middle Initial) _________

 

Complete Former Name: (Last)_________________________   (First) ______________________ (Middle Initial) _________

 

 

SOCIAL SECURITY NUMBER CHANGE/ CORRECTION 

 

Please attach a copy of your Social Security Card and a Photo ID. You must obtain a new student 
identification card once processed. 

 

Enter new Social Security Number: ________________-_____________-______________ 

 


Return this completed form to: 

Office of the Registrar 

Shuster Hall, Room 102