Temple University: Office of Student Academic Records

SOCIAL SECURITY NUMBER CHANGE REQUEST FORM

----A copy of your social Security Card must accompany this form.----


______________________________ ,_______________________ __
Last Name                       First Name            MI     
(Please print)


_______________________________           __________________________
Previous Social Security Number           New Social Security Number 
      or Student ID		             


_____________________________________________________________________________
_____________________________________________________________________________

CERTIFICATION 


I, _____________________________________ hereby certify that I formerly used
the ID/SSN _________________________ and that Temple University maintained 
my scholastic records under that number. Please update my records to reflect 
the correct number - _________________________.


YOUR SIGNATURE (required)_____________________________________ Date:_________

Mail Request To:
Temple University
Office of Academic Records
1801 N. Broad St.
Philadelphia, PA 19122

Fax Request To:

(215)204-6626

If you have questions or suggestions, please send us e-mail at arecords@temple.edu.

Temple University requests your Social Security Number because federal, state and local law requires the University to report the name, address, and SSN for certain purposes. Temple University will not disclose your SSN without consent unless it is required to do so by law, or as permitted by the University's Social Security Number Usage Policy (http://policies.temple.edu/getdoc.asp?policy_no=04.75.11).