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KENTUCKY STATE UNIVERSITY OFFICE OF THE REGISTRAR PHONE: 502-597-6340 FAX: 502-597-6239
Data Change Form
Personal data submitted at the time of admission will remain unchanged, until filling out this form to indicate changes.
Note: Permanent address changes from Non-Kentucky addresses are prohibited unless approved by the Director of the Registrar, Admissions and Community Programs.
Please complete the following with both prior and updated information.
NOTE: Students must present proof of documentation to the Office of the Registrar.
OLD DATA (Presently in records)
Name:
Last
First
MI
Maiden
Last First MI Maiden
Social Security Number:___
Social Security Number
NEW DATA (To be updated in records)
Name:
Last
First
MI
Maiden
Last First MI Maiden
Social Security Number:___
Social Security Number
FOR OFFICE USE ONLY
Date Received/Entered:___ By:___
Date Received/Entered
It is the Policy of Kentucky State University not to discriminate against any individual in any of its educational programs, activities, or employment on the basis of race, color, national origin, sex, disability, veteran status, age, religion, or marital status.