Social Security Number Change Form - University of Nebraska at Kearney
Social Security Number Change Form
A copy of your signed Social Security Card must be submitted with this form.
To protect your identity, never fax or email a social security number. Please print and mail this form with the appropriate documents to:
University of Nebraska Kearney Registrar's Office - Warner Hall 2504 9th Ave Kearney, NE 68849
NUID Number ______________________
Name: _______________________________________________________________________
First
Middle
Last
Address: ______________________________________________________________________
Street
City
State
Zip
Phone (____)__________________________________ Birthdate:_________________
Correct Social Security Number: _________________________
Incorrect Social Security Number: ________________________
I certify that the information provided is accurate and correct and that I am the owner of this information. I hereby authorize the University of Nebraska at Kearney to update my social security number on my record. I authorize the Registrar's Office to provide a copy of my social security card to the Human Resources Office at the University of Nebraska at Kearney to update any applicable employment record.
Student's Signature: ____________________________________________Date_____________
12/11/17
................
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