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 Vickie Kuester at 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