Registrar’s Offic e
303-273-3200
CHANGE OF PERSONAL INFORMATION
When completing this form, please print legibly and use ONLY Black or blue INK, no pencil

CURRENT/PREVIOUS NAME: _____________________________________

CWID: __ __ __ __ __ __ __ __

1. ARE YOU EMPLOYED ON CAMPUS?
YES: An updated copy of your Social Security Card MUST be provided to Human Resources in order to receive paychecks.
NO

2. ARE YOU AN INTERNATIONAL STUDENT? To change your Visa type, contact International Student & Scholar Services
YES: You must provide a passport for name changes.
NO

3. WHAT WOULD YOU LIKE TO DO?
Change or Correct your Name –
If filling out this section: ORIGINAL OR NOTARIZED COPY OF PASSPORT/PERMANENT VISA OR DRIVER’S
LICENSE/STATE ID OR OTHER GOVERNMENT ISSUED PICTURE ID

______________________
______________________
______________________
_____
Last



First



Middle


Suffix

Update Social Security Number –
If filling out this section: PROVIDE ORIGINAL OR NOTARIZED COPY OF SOCIAL SECURITY CARD

Add/Correct Social Security Number: ___ ___ ___ -- ___ ___ -- ___ ___ ___ ___

Correct Date of Birth –
If filling out this section: ORIGINAL OR NOTARIZED COPY OF BIRTH CERTIFICATE OR PASSPORT

Correct Date of Birth: __ __ / __ __ / __ __ __ __ (mm/dd/yyyy)

Change or Correct Gender –
If filling out this section: ORIGINAL OR NOTARIZED COPY OF BIRTH CERTIFICATE OR MEDICAL
DOCUMENTATION FOR GENDER CHANGE
Change/Correct Gender:

Male
Female

Change or Correct Ethnicity
-
Are you of Hispanic or Latino descent?
YES NO
-
Check one or more of the following groups in which you consider yourself to be a member.
__American Indian or Alaska Native
__Native Hawaiian or other Pacific Islander


__Asian
__White

__Black or African American

Change or Correct Citizenship
If filling out this section: ORIGINAL OR NOTARIZED COPY OF PASSPORT, CITIZENSHIP CERTIFICATE OR
PERMANENT RESIDENT CARD
Change/Correct Citizenship:

Permanent Resident
US Citizen

4. IS THE ABOVE INFORMATION CORRECT?
By signing below, I certify that the above information is correct and that I am responsible for any changes
maSde tigno myatu preerso: _nal__ infor___mation
___
re___cord___. I wil___l ver___ify my
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Date: _____________






OFFICE USE ONLY

PLEASE ATTACH COPIES OF SUPPORTING DOCUMENTATION TO THIS FORM.
Processed: ______ ____ Date: ____ ______



Revised 3/28/2017

Document Outline