FORMER STUDENTS
STUDENT INFORMATION UPDATE
California State University, Chico
Office of the Registrar
Student Services Center, Room 110
Chico, CA 95929-0720
Phone: (530) 898-5142
Fax: (530) 898-4359
registrar@csuchico.edu
If you are a current CSU, Chico employee (AS & Foundation not included) you must also change your information in
Human Resources Service Center, KNDL 220.
09/15
Mark and complete only the section(s) which require update.
Complete this form if you are a former student to update the items listed below.
Name:
Last First Middle
(Name currently on CSU, Chico record)
Former Name(s): Last Enrolled
Semester Year
Chico State ID (if known): Date of Birth
STUDENT SIGNATURE Date
Legal Name
CSU, Chico will use your legal name. If you are a current CSU, Chico employee (AS or Foundation not included) you may also
need to change your name in Human Resources, KNDL 222.
Provide a copy of one of the following: Driver’s License, Identification Card, Social Security Card, or Court
Documentation
Correct Name
Last First Middle (Maiden)
Office Use Only
PS Record IN
Date of Birth
Provide a copy of one of the following: Driver’s License, Identification Card, or Birth Certificate
Date of Birth
Month Day Year
Office Use Only
PS Record IN
Social Security Number
If you are a current CSU, Chico employee (AS or Foundation not included) you will need to change your SSN in Human
Resources, KNDL 222. We cannot process your request.
Provide a copy of your Social Security Card.
SSN on record -- --
Correct SSN -- --
Office Use Only
PS Record IN
