Student Information Correction Request

Student Information Correction Request
To request a correction to your name, social security number or date of birth to be corrected in our system:
1. Complete this form.
2. Include all the appropriate documentation (see list below). Documentation will be shredded once changes have been made.
REQUESTS WILL NOT BE PROCESSED WITHOUT APPROPRIATE DOCUMENTATION.
BMCC ID or SSN
Name

Current First NameCurrent Last Name
MI
Other Names Used
Other SSNs/BMCC IDs used at BMCC
Address

Mailing Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth

MonthDayYear
Date
Phone
Format: (000) 000-0000.
Email
example@example.com
Type of Request: (Indicate reason for request.)
Required Documents based on selection above.

MUST PROVIDE ALL DOCUMENTS REQUESTED BELOW.

Name Change: (marriage, divorce or legal name change)
- Copy of one of the following (current): Driver's license, State ID, Government ID, or Tribal ID; AND
- Copy of Social Security Card; AND
- Copy of one of the following: divorce decree, marriage certificate OR other documentation that includes both your prior name and current last name. Prior name on documentation must match what is our system.
Social Security Number Correction
- Copy of Social Security Card; AND
- Copy of one of the following (current): Driver's license, State ID, Government ID, or Tribal ID
Duplicate Account
- Copy of Social Security Card; AND
- Copy of one of the following (current): Driver's license, State ID, Government ID, or Tribal ID
Date of Birth Correction
- Copy of one of the following (current): Driver's license, State ID, Government ID, or Tribal ID (must show Date of Birth)
Name Correction
- Copy of one of the following (current): Driver's license, State ID, Government ID, or tribal ID; AND
- Social Security card
Upload all documentation per requested correction needed

Cancelof
I verify that the information and supporting documentation provided are valid.
Student Signature
Date

MonthDayYear
Date
Blue Mountain Community College is an equal opportunity educator and employer.
Should be Empty: