This form is provided for KSU students who wish to print and submit a form to the Office of the Registrar. When completed, you may fax the form to (770) 423-6541, mail it to 1000 Chastain Road, Box #0116, Attn: Office of the Registrar, Kennesaw, Georgia, 30144-5591; or, bring it to the Office of the Registrar during normal operating hours.

KENNESAW STATE UNIVERSITY
NAME & SOCIAL SECURITY NUMBER CHANGE

***MUST HAVE COPY OF LEGAL DOCUMENTATION ATTACHED***
PLEASE PRINT

NAME:



 KSU #:
   
Fill out the section(s) appropriate for the changes you wish to be made to your KSU record.
New Name: (Must be accompanied by a court order, divorce decree, marriage license, or other legal documentation)

New Social Security Number: (Must be accompanied by a copy of Social Security Card)
Have you petitioned to graduate: (check one)

Yes _______

No   _______

New Telephone Number:

Home: __________________________

Work: __________________________
Student's Signature:



 Date:

FOR OFFICE USE ONLY:


  Date Completed:____________________        Initials: ____________________