Sacramento City College
CHANGE OF DATA FORM
**PLEASE PRINT CLEARLY**
STUDENT INFORMATION
Name: ________________________________________________________________ Student ID: __________________
Email: _________________________________________________________________ Phone: (_____) _______________
Semester: □ Summer □ Fall □ Spring Year: ______________ F-1 Visa Student: □ Yes □ No
All requests require a photo I.D. and any supporting documentation if applicable.
Los Rios employees must submit all name or address changes to the SCC Business Office.
Please check all applicable boxes.
I hereby authorize the SCC Admissions and Records Office to make the following correction(s) to my record:
□ New Name: ____________________________________________________________________________________________
Last, First, Middle Initial
□ Social Security: _____________________________________________
XXX - XX - XXXX
□ Date of Birth: _____________________________________________
MM/DD/YYYY
□ Phone Number: (_______) _____________________________________
□ Emergency (WARN) Phone number: (________)____________________ Accepts Texts? □ Yes □ No
□ Email: _____________________________________________________
□ Address: _____________________________________________________
Street Address
____________________________________________________
City State Zip
□ Major: ____________________________________________________________ Major Code: ____________________
□ Educational Goal - Please select one of the following.
___ A: Transfer to 4-year after AA/AS Degree ___ D: Earn a Vocational Degree without Transfer
___ B: Transfer to 4-year without AA/AS Degree ___ E: Earn a Vocational Certificate
___ C: Earn AA/AS Degree without transfer ___ Other: ____________________________________
**Please see A&R staff for complete list
□ Update graduation status on record:
___ I earned a High School Diploma: ____________________________________________________________________
HS Name MM/YYYY State & Country
___ I earned a GED or equivalent: ______________________________________________________________________
Date Earned State & Country
___ I did not earn a High School Diploma or equivalent.
___ Other correction: ________________________________________________________________________________
STUDENT SIGNATURE: DATE:
Change of Data Rev 10-03-17
Admissions Use Only:
Processed By: ___________________
Date: ___________________
Comment: ___________________
For Name Changes:
Please provide at least two forms of
government issued I.D. with your request
and/or a copy of the official name change
document from the court.
click to sign
signature
click to edit
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