Student Update Form Chaffey College
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1FALL
SPRING
SUMMER
5885 Haven Avenue, Rancho Cucamonga, CA 91737
YEAR:
ADMISSIONS AND RECORDS OFFICE
STUDENT UPDATE FORM
Please Print - Use Black or Blue Ink Only (Do not use pencil)
Chaffey ID #
Social Security #
Student Name
Last
First
MI
SOCIAL SECURITY NUMBER, NAME and/or DATE OF BIRTH CHANGE
(Must present Social Security card ALONG WITH CA driver’s license, marriage certificate, birth certificate, or other government issued I.D.)
PLEASE CHANGE MY SOCIAL SECURITY NUMBER AS FOLLOWS:
Incorrect Number
Correct Number
PLEASE CHANGE MY NAME AS FOLLOWS:
Previous Name
Last
First
MI
Current Name
Last
First
MI
PLEASE CORRECT MY DATE OF BIRTH AS FOLLOWS (MM/DD/YY):
Wrong DOB
/
/
Correct DOB
/
/
PRINCIPLE EDUCATIONAL GOAL
PLEASE CHANGE MY PRINCIPLE EDUCATIONAL GOAL TO: (Check applicable box)
A
Obtain Bachelor's degree after completing Associate degree
H
Advance in current job/career (update job skills)
B
Obtain Bachelor's without completing Associate degree
I
Maintain certificate or license (e.g. Nursing)
C
Obtain two-year Associate degree without transfer
J
Educational development (intellectual, cultural)
D
Obtain two-year vocational degree without transfer
K
Improve basic skills in English, reading, or math
E
Earn vocational certificate without transfer
L
Complete credits for high school diploma/GED
F
Discover/formulate career interests, plans, goals
M
Undecided goal
G
Prepare for new career (acquire job skills)
OTHER MISCELLANEOUS CHANGES (Please describe):
I DO NOT WANT MY DIRECTORY INFORMATION RELEASED TO ANYONE.
Student Signature
Date
OFFICE USE ONLY
REQUEST SOCIAL SECURITY CARD FOR
NAME AND SOCIAL SECURITY NUMBER CHANGES. ATTACH COPY OF SSN CARD
I.D. CARD TO FORM.
Processed by/Date:
CHANGES COMPLETED (Mark all that apply):
Social Security Number Change
Name Change
Date of Birth Change
Principle Educational Goal Change
FERPA Block
Other Misc. Change
FOR DOB CHANGES-ONLY
Date of Birth Change – Update field on PPIN and DRUS
(Revised: 01/29/15)
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