Admissions & Records
College of the Siskiyous, 800 College Ave., Weed, CA 96094
Phone: (530) 938-5500 - Fax: (530) 938-5367 Email: registration@siskiyous.edu
Change of Student Information
Please send any required documentation to registration@siskiyous.edu
Last Name: First Name: MI:
Date of Birth: Student ID#: S00 or SSN:
COS Email: Phone:
Mailing Address:
City: State: Zip Code:
Type of Change
Please check and complete only the sections below, which require change.
Social Security Number Change: (Please provide copy)
SSN:
Name Change:
Name:
(Please provide legal documentation)
Preferred Name:
Local Address/Phone Change Permanent Address/Phone Change
Street Address:
City: State: Zip:
Phone:
Personal Email Change
Email Address:
Confidential Directory Information
Make my Information Confidential: Yes No
Student Signature: Date:
Office Use Only
Signature Date
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