Office of the New Brunswick Registrar, Administrative Services Building (Busch Campus)
       Undergraduate-Rm200B, Graduate-Rm200F, 65 Davidson Road, Piscataway,  NJ  08854-8096

 REQUEST TO CHANGE  STUDENT I.D. NUMBER - (Please Print)

This form must be returned to our office in person. Two forms of original identification are required (we will xerox them)

1.  Current Name: _________________________________________________________________________
                                                Last                                              First                                 Middle Name or Initial

2.   Current Student I.D. Number: ________________________________      Telephone #____________________________
 
       Registrar Assigns New Student I.D. Number: ________________________________

3.  If currently enrolled, complete the following:

      Current School /College Attending: ___________________________________________

      Other Rutgers Schools of Attendance: _________________________________________

4.  If not currently enrolled, complete the following:      Date of Birth: _____________________

      Last School of Attendance:___________________________________________________

      Other Rutgers Schools of Attendance:_______________________________________________

      Degree(s) Awarded and Year(s) Awarded:______________________________________________

4.  I submit __________________________ and __________________________ (a copy of your driver's license, Rutgers
     Student I.D. card, voter registration card, marriage license, court order, social security card, etc.) as identification.

5.    STATEMENT BY STUDENT:

        I affirm that the request for a change of Student I.D. Number on the Rutgers University Registrar’s Student Records
        has no fraudulent or criminal purpose.

        __________________________________________________                    __________________________
                                  Signature                                                                         Date
= = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = =
  6/7/05                                                                                For Registrar’s Office Use Only

Maintenance completed:_________________________                    Permanent Record Card corrected:_______________________
                                                  Date                                                                                                                        Date
cc:    Dean of Students – Active Students Only                              Financial Aid Office – Active Students Only
        Dean of College/School – Active Students Only                     Business/Cashier Office – Active Students Only
        Alumni/Alumae Office – Degree Holders Only