SUNY Orange
Bursar
Change of Information Form

     Current Information on File				Updated Information

Name:___________________________________          Requested Name Change:________________________________

Student ID #A____________________________

Social Security #:_________________________	      Correct Social Security #:________________________________

Former Residence Address:                                      New Residence Address:

__________________________________________         _________________________________________________________

__________________________________________         _________________________________________________________

Mailing Address: (If different from residence address)


Effective Date of Change:_______________________________________________________________________________

Telephone #’s       Home:________________________________Cell:________________________Work:_______________________________

Signature:______________________________________________Date:__________________________________________
Change Requirements
Name change requires a copy of marriage certificate, divorce decree, or other legal document permitting name change.  * A driver’s license cannot be used for a name change.

Social Security number change requires Social Security Card.

Legal address change within the same county requires postmarked document with new address on it.  Mailing address change requires postmarked document with new address on it.
Address change to Orange County from other county requires document with date of change such as utility bill, cable bill, telephone bill, etc (Rental agreement alone cannot be used for legal address change).  Address change to New York State residence from an out of state address requires New York State Income Taxes (Parent’s State and Federal if dependent), New York State Driver’s License and one other document proving New York State for one full year.  

       Office use only

Name:____________	Address – PR:_____________	Telephone:_______________	SS#:____________________
			  Add PO Box :_____________

County:______to________        Citizenship:_____to______      Residence:_____to______   Reassess Fees:_________

Bursar:________________         Date:___________________       Registrar:_____________    Date:___________   (12/09)