Change of Information Request Form

__________________________________________________________________________________________

This form may be utilized to change/correct ONLY the following information:

-Addresses (both physical and mailing)
-Phone Numbers
-Social Security Number
-Date of Birth

For all other changes, including NAME CHANGES, please visit
SUNY Orange's Student Services Central Office on either campus.

_____________________________________________________________________________________________

1Change of Information > 2Verification, Signature & Submission
Student ID #
Social Security Number:
Student's Name: Student's Name: * First Last
Date of Birth Date of Birth * / MM / DD YYYY
_____________________________________________________________________________

Address Change (physical address, no P.O. Boxes).

_____________________________________________________________________________

Address Change (physical address, no P.O. Boxes). Yes, I would like to change my physical address No
*New Physical Address
(NO P.O. Boxes) *New Physical Address
(NO P.O. Boxes) *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
*Enter the County Name the physical property is located in:
(Example: Orange, Sullivan, Ulster, etc) *
Maximum of 50 characters allowed. Currently Entered: 0 characters.
*Please upload: Recently postmarked mail with the student's name and new physical address *

Attach Files
_____________________________________________________________________________

New Mailing Address (only required if different from physical address)

_____________________________________________________________________________

New Mailing Address (only required if different from physical address) Yes, I would like to add or change my mailing address No
*New Mailing Address
(Only required if different from physical address) *New Mailing Address
(Only required if different from physical address) *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
*Enter the County Name, the ,mailing address is located in:
(Example: Orange, Sullivan, Ulster, etc) *
Maximum of 50 characters allowed. Currently Entered: 0 characters.
*Please upload: Recently postmarked mail with the student's name and new mailing address *

Attach Files
_____________________________________________________________________________

New Phone Number(s)

_____________________________________________________________________________

New Phone Number(s) Yes, I wish to update my cell and/or home phone number(s). No
New Cell Phone Number: New Cell Phone Number: - ### - ### ####
New home phone number: New home phone number: - ### - ### ####
_____________________________________________________________________________

Social Security Number

_____________________________________________________________________________

Social Security Number Yes, I would like to add or correct my Social Security Number on my account. No
Enter you Social Security Number:
Please upload, the following information for a correction or to add your Social Security Number to your student account:

1.) Copy of your Social Security Card

2.) Completed Substitute W-9S Form, which can be found by clicking here or by copying and pasting and pasting the following link: https://sunyorange.edu/studentaccounts/forms.html

Attach Files
_____________________________________________________________________________

Date of Birth Correction

_____________________________________________________________________________

Date of Birth Correction Yes, my Date of Birth needs to be corrected No
Please enter your correct date of birth: Please enter your correct date of birth: * / MM / DD YYYY
*Please upload a copy of your original birth certificate below *

Attach Files
Save my progress and resume later
Enter Your Email Address *

A special link to resume the form will be sent to your email address.

Change of Information Request Form

Change of Information Request Form

This form may be utilized to change/correct ONLY the following information: -Addresses (both physical and mailing) -Phone Numbers -Social Security Number -Date of Birth For all other changes, including NAME CHANGES, please visit SUNY Orange's Student Services Central Office on either campus.

This form may be utilized to change/correct ONLY the following information:

-Addresses (both physical and mailing)
-Phone Numbers
-Social Security Number
-Date of Birth

For all other changes, including NAME CHANGES, please visit
SUNY Orange's Student Services Central Office on either campus.