Bowie State University - Office of the University Registrar - 14000 Jericho Park Road, Suite 1200, Bowie, Maryland 20715   Fax: 301-860-3438

Data Correction Form Please complete the appropriate section.  Accuracy is absolutely necessary.  Please note that no changes will be completed without proper documentation. Student ID#: ________________________      Date of Birth: ______________________ Last Name __________________________      First Name ________________________    M.I._______

Section I:     Change of Address Previous Address:       New Address:     Daytime #:____________________          Evening #:________________ Section II:     Change of Name Must attach a government issued documentatio (i.e., birth certificate, marriage certificate, divorce decree, court petition)   Previous Name: Last Name: _____________________    First Name: ______________________   M.I.______ New Name: Last Name: _____________________    First Name_______________________   M.I.______ Reason for change: ____________________________________________________________________ Section III:     Change of Social Security Number    Must attach a copy of government issued social security card Previous Social Security #: _________________________________ New Social Security#: _____________________________________ I certify that the information provided is complete and accurate. Student's Signature: _________________________________________            Date: ______________

Office Use Only//Processed by: _____________________________                       Date: ___________

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