Change of Social Security Form
Simon Graduate School of Business Administration
University of Rochester
Registrar’s Office, 305 Schlegel Hall Box 270107
Rochester, NY 14627
Directions:
• Please complete this form if your social security number has changed.
• Please return the completed form to the Registrar’s Office, 305 Schlegel Hall. You’ll need to present
your original social security card as proof of change.
Name: _____________________________________________________________________________
Last
First
Middle
Program you are enrolled in: ___________________ Degree: ____MBA ____MS ____PhD
Old social security number: _________________________________________
New social security number: _________________________________________
Are you a current student?
 Yes
 No
University ID #:________________________
Date of Birth: ________________________________
If not currently enrolled, when did you last attend the Simon School? _________________________
Are you an international student?
 Yes
 No
Student Signature: _______________________________________________Date: ______________
Mo.
Day
Yr
For Registrar’s Office Use Only
Date Received: _____________
Date Processed: _____________
Processed By:
_____________
3/2013