Change of Name/DOB/SSN

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Change of Name

Revision 04/22/26

Enrollment Services
Office of Records

www.ColumbiaState.edu/Records

931-540-2581

Change of Name, Date of Birth, and/or Social Security Number

Form Instructions:

For Name Changes: Copy of driver's license, marriage certificate, or social security card is REQUIRED.

For Date of Birth Changes: Copy of driver's license or birth certificate is REQUIRED.

For Social Security Changes: Copy of social security card is REQUIRED.

Your Information:

Student ID

First Name:

Last Name:

Email:

Phone:

Name Change

Date of Birth Change

Social Security Change

Columbia State Community College, a Tennessee Board of Regents institution, is an equal opportunity institution.

By signing this worksheet, I certify that all the information reported is complete and correct.

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