UCCS STUDENT RECORD CHANGE REQUEST

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UCCS STUDENT RECORD CHANGE REQUEST

First Name Middle

(Name currently on record)

_

Last

_

Student ID

1. You must select and provide a copy of one of the following documents as proof for the requested change:

Valid Driver’s License

Passport

Social Security Card

Birth Certificate

State Issued ID

Military ID

Official Marriage License

Court Divorce Forms

W-2 Form

Official Court Name/Gender Change Documents

_

DOB

2. CHANGES/UPDATES

Please select and fill out the appropriate and correct information for requested changes/updates to be made to your student records:

Name Change:

First Name Middle Name

_

Last Name

Preferred First Name Reason

_

Birthdate: (please fill in correct date of birth):

Social Security or Tax Payer Identification Number:

Gender: Male Female Other, Please Explain ______________________________

3. STUDENT AUTHORIZATION

Student Signature Date

Important Notes

: (1) Official documentation and identification must be provided to the Records office by the student before changes can be made to student records. (2) Allow 5-7 business days for processing.

University of Colorado Colorado Springs

Office of the Registrar

1420 Austin Bluffs Pkwy | Colorado Springs, CO 80918

Phone (719)255-3361 | Fax (719)255-3116 | [email protected]

| www.uccs.edu

Rev. 03/2014

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