Change of Student Data Request
Admissions and Records
2300 E. Gibson Road, Woodland, CA 95776
(530) 661-5700
PLEASE PRINT CLEARLY USING BLUE OR BLACK INK
Student ID: Date: / /
Name:
Last First Middle
PLEASE CHANGE THE FOLLOWING TO:
New Name: (Please aach documentaon)
Last First Middle
New Social Security Number: (Please aach copy of SSN card)
Correct Birth Date: / / (Please aach documentaon)
New Mailing Address:
City State Zip
New Phone Number: ( )
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 educaon associate’s degree, A.A. I—Maintain cercate or license
D—Earn a vocaonal associate’s degree, A.S. J—Educaonal development
E—Earn a vocaonal cercate K—Improve basic skills in reading, math, etc
F—Explore career interests, plans and goals L—Complete high school credits
Educaonal Goal Opons:
Student Signature:
FOR OFFICE USE ONLY: Ed Goal Updated on MATI: Major Changed on SPRO:
Received by: Date Received: Date Processed:
Revised 10/12
New Major: (Please see College Catalog for Major opons)
New Educaonal Goal: (Please see opons below)
click to sign
signature
click to edit
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