College of Charleston Date of Birth Correction Request Form | RO/OLA | version 2-21-19 prior form versions will not be accepted
STUDENT DATE OF BIRTH CORRECTION REQUEST
This form is used to request a correction to the date of birth on file with the Office of the Registrar. Students must
present a signed Date of Birth Correction Request form along with the following appropriate original documentation
to the Office of the Registrar. All forms used for Personal Information Updates must be completed in blue or black
ink and may not contain any scribbled or marked out data.
We require the following documentation:
o *valid state or U.S. government issued photo identification AND
o the original or *notarized copy of the student’s birth certificate OR
o the original or *notarized copy of the student’s valid U.S. passport (if non-U.S. passport is provided, a
cop
y of the student’s U.S. visa document is also required)
*NOTE: All copies must be notarized by a commissioned notary and accompanied by the affidavit included with the
Date of Birth Correction Request form. Color copies of documentation are preferred. While notarized copies are
accepted for specific situations listed above, the College of Charleston reserves the right to demand production of a
certified original or color copies at the sole discretion of the University Registrar (or University Registrar’s designee).
All requests may be subject to review by the Office of Legal Affairs (OLA).
NOTICE: Identification theft is taken seriously by the College of Charleston and will be prosecuted to the fullest
extent available under law. Completed forms and documentation must be submitted in person by the individual
requesting the change or via postal mail, no exceptions. The College of Charleston reserves the right to request
further evidence to authenticate identity for all date of birth correction requests.
College of Charleston Date of Birth Correction Request Form | RO/OLA | version 2-21-19 prior form versions will not be accepted
STUDENT DATE OF BIRTH CORRECTION REQUEST
Student Status
I am a currently enrolled student. I am a former student.
A
s of ___________________________ [date MM/DD/YYYY], I hereby request that my date of birth be corrected on my
official College of Charleston records as follows:
Student Name (please print clearly)
Last
First
Middle
C
ofC ID (CWID) -- OR -- Social Security Number (Last 4 Digits)
_____ _____ _____ _____
S
tudent Contact Information
Email Address (current students must use their college-issued email)
Daytime Phone Number
D
ate of Birth
Incorrect Date of Birth
Correct Date of Birth
________/________/________
MM DD YYYY
________/________/________
MM DD YYYY
B
y my signature below, I hereby attest and certify that all the information and documentation provided by me for this Date
of Birth Correction Request is correct and complete. I understand the College of Charleston reserves the right to request
further evidence to authenticate my identity or require production of a certified original of a document at the sole discretion
of the University Registrar
(or University Registrar’s designee).
___
____________________________________________________________________________________________________________________
Signature Date (MM/DD/YYYY)
RO OFFICE USE ONLY
Documentation Provided (check all that apply)
☐Valid photo ID
☐Birth Certificate
☐Passport/Visa Expiration: /
☐Notary commission validated
Approved by: (RO Official Initials)
Processed by: (RO Staff Initials)
Date: _____/______/______
College of Charleston Date of Birth Correction Request Form | RO/OLA | version 2-21-19 prior form versions will not be accepted
AFFIDAVIT
State of ____________
County of __________
On this _____ day of ___________________, 20____, I, _____________________ (Document Holder), holder of
_____________________________ (Name of Documents), consisting of ______ pages, do hereby swear/affirm, and attest
that it is a true, exact, complete and unaltered photocopy of the original. To the best of my knowledge and belief, the
photocopied document is not a public record, of which certified copies are available from an official source.
_________________________________
Signature of Affiant
Sworn to (or affirmed) and subscribed before me this the _____ day of _______________, 20_____.
________________________________
Official Signature of Notary
(Official Seal)
____________________, Notary Public
Notary’s printed or typed name
______________ County,
_______________ (State)
My commission expires: _______________
*The county listed at the top of the affidavit is the county where the notarization is taking place. The county near the notary’s signature is the notary’s
county of residence.
