Request for Student Record Change

Request for Student Record Change
Purpose:

To provide students the opportunity to change their record (name or social security number) on file with the Registrar’s Office. Students wanting to change their mailing address, email, or phone number, should do so through LoLa. (Related Policy: Catalog Year, found in the 2019-2020 Catalog and referenced below)
Student Information
Name*

First NameLast Name
LOLA ID (Student Id)*
Phone Number

Area CodePhone Number
Email*
example@example.com
Type of Record Change Being Requested (select all that apply)*

Social Security NumberName ChangeDate of Birth
Name Change: Attach official documentation- marriage certificate, divorce decree, birth certificate or court order and photo identification
From: Last, First Middle*
ex. Doe, Jane F
To: Last, First Middle*
Smith, John D
Reason for Change of Name*

MarriedDivorcedOther
Marriage Certificate/Divorce Decree/Court Documentation/Birth Certificate*

Browse Files

Cancelof
Photo Identification*

Browse Files

Cancelof
Change of SSN: Attach official documentation- Driver's License/State ID or Passport, or Social Security card and Photo Identification
From:*
Enter Number on file
To:*
Enter correct number
State ID/Military ID/Passport*

Browse Files

Cancelof
Social Security Card*

Browse Files

Cancelof
Birth Certificate/Birth Card*

Browse Files

Cancelof
Additional notes for either/any of the above requests
Signature*

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Request for Student Record Change

Purpose: