Social Security Number Release Form
UW-Stout
This form must be completed by the student.
My signature below gives the Social Security Office (at 4120 Oakwood Hills Parkway) permission to immediately fax my
Social Security Number (SSN) to the University of Wisconsin-Stout Office of International Education.
I understand that I will also receive my Social Security card directly at the address shown on my application.
_____________________________________________________________
Name (Exactly as it appears on your visa – PLEASE PRINT CLEARLY)
_____________________________________ ____________________
Signature
Date
********************
To: UW-Stout Office of International Education
Fax: 715.232.2500
Date: ________________
Subject: SSA Verification of social security number for above named student:
Following is verification of the social security number which was just assigned for this student. The card should be
received within one to two weeks.
________________________________________________
Signature of SSA Representative Furnishing this Information
Revised 7-09-2012