PLE
ASE PRINT CLEARLY USING BLUE OR BLACK INK
Change of Student Data Request
Admissions and Records
2088 North Beale Road, Marysville, CA 95901
(530) 741-6720
Student ID: Date: / /
Name:
Last First Middle
PLEASE CHANGE THE FOLLOWING TO:
New Name: (Please attach documentation)
Last First Middle
New Social Security Number: (Please attach copy of SSN card)
Correct Birth Date: / / (Please attach documentation)
New Mailing Address:
City State Zip
New Phone Number: ( )
New Major:
Major to remove:
New Educational Goal:
Educational Goal to Remove:
Educa
tional Goal Options:
(Please see College Catalog for Major options)
(Please see options below)
A—Transfer to four-year college with an associate’s degree G— Learn job skills (new career)
B—Transfer to a four-year college without an associate’s degree H—Update current job skills
C— Earn a general education associate’s degree, A.A. I—Maintain certificate or license
D—Earn a vocational associate’s degree, A.S. J—Educational development
E—Earn a vocational certificate K—Improve basic skills in reading, math, etc
F—Explore career interests, plans and goals L—Complete high school credits
Student Signature:_____________________
Major Changed on SPRO:
Date
Processed:
Revised 04/2020
Ed Goal Updated on MATI:
Date Received:
FOR OFFICE USE ONLY:
Received by:
