Registrar: Records Research Form

Records Research 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
Records Research Form
This form is to gather sensitive information such as the social security number in a secure way.
Please only use this form if directed by the Registrar staff to provide your SSN to locate your record. If you need to change your SSN, please use the Social Security Card Submission Form instead.
*

I understand this form is not intended to update my student record.
Student Name Student Name * First Middle Last
(First Name, Middle Name or Initital, Last Name)
Social Security Number: *
Must be between 8 and 11 characters. Currently Entered: 0 characters.
This is very important to obtain as many records prior to the current database system were stored under the social security number.
Date of Birth Date of Birth * / MM / DD YYYY
Email Address: *
University ID Number (if known):
Must be 8 characters. Currently Entered: 0 characters.
*

I certify under penalty of disciplinary action that the information I have provided is true.
Signature (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
Upload a File (optional)

Attach Files
Please allow 3-5 business days for processing.
-- BDMS -- Index to: Correspondence - Records