Registrar Change of Information Form

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Current Name

First Middle Last Suffix

Current First Name*

Current Middle Name*

Current Last Name*

Current Suffix*

Date of Birth*

Do you have a change of name or need to correct your Social Security number in our system?*

No
Yes, I have a name change.
Yes, I need to update my social security number.

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Do you need to correct your Social Security number or name in our system?

No
Yes

Former Name*

First Middle Last Suffix

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You will need to attach an image of your Social Security Card for name change verification.

Accepted file types: pdf, png, jpg, Max. file size: 64 MB.

You will need to attach an image of your Social Security Card for name change verification.*

Accepted file types: pdf, png, jpg, Max. file size: 64 MB.

Do you know your Faulkner ID number?*

Yes
No

If you need to submit additional information or any explanations along with the above changes. Please email the Registrar’s office directly at registrar@faulkner.edu .

Faulkner ID Number*

SSN*

Contact Number*

Alternate Number

Email*

Enter Email Confirm Email

Mailing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Signature*

I agree that the above information is accurate, and that I am the student whose name appears on this form

Phone

This field is for validation purposes and should be left unchanged.

Introduction

Registrar Change of Information Form