Registrar: Social Security Card Submission Form

Social Security Card Submission Form
Office of the University Registrar
Division of Academic Affairs

1009 Rollins Hall ● Norfolk, VA 23529-0052 ● Telephone: (757) 683-4425 ● Fax: (757) 683-5357
Social Security Card Submission Form
This form is to update your current social security number on file. Please do not use this form to request a name change (please complete the Address/Name Change Form instead). Please complete the information below and attach a copy of your Social Security Card below.
Student Name Student Name * First Middle Last
(First Name, Middle Name or Initital, Last Name)
University ID Number: *
Must be 8 characters. Currently Entered: 0 characters.
Date of Birth Date of Birth * / MM / DD YYYY
Email Address: *
*

I certify under penalty of disciplinary action that the information I have provided is true.
Signature of Applicant (draw or type) *

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Date Date / MM / DD YYYY
Please submit an image (.jpg, .jpeg, or .png) or scanned .pdf copy of your Social Security Card
Upload a File

Attach Files
Please allow 3-5 business days for processing.
-- BDMS -- Index to: Address/Name/SSN Change Forms