Personal Identification Change Form

Please attach at least two valid forms of Identification (at least one Photo ID is required):

Both forms of the required identification must show the NEW name.

What change(s) are you submitting?

First Name

Last Name

Are you currently a student at SUNY Plattsburgh?

Yes

No

Banner ID (if current student)

Are you a degree candidate?

Yes

No

If yes, what term and year you expect to graduate?

Email Address

Phone Number (with Area Code)

Former Last Name

Former First Name

New Last Name

New First Name

New Middle Name/Middle Initial

Date of Birth

Current Social Security Number

If applicable, New Social Security Number

Gender Change?*

Yes

No

*DMV (state government issued) License or U.S. Passport required along with another form of ID listed above

Other demographic change:

Please type full name (I understand that this is a legal representation of my signature):