Peralta Community College District
Admissions and Records
Berkeley City College
College of Alameda
Laney College
Merritt College
PERSONAL INFORMATION UPDATE
X
Student's Signature
Date
Received by:
Name (please print clearly)
Date:
Date:
Rev. 04/10/2020
Add/update
my social security number to my student record:
Last Name
First Name
Previous Name:
Current Name:
Processed by:
/
/
SOCIAL SECURITY NUMBER
NAME /DATE OF BIRTH
Middle Name
Preferred Name:
(This shows only in
Passport & instructor roster)
Last Name
Last Name
First Name
Middle Name
Middle Name
First Name
Correct my date of birth as follows ( MM/DD/YY):
Original and signed Social Security Card must be presented along with a Government issued photo ID Card
Proof of Government issued photo ID is required PLUS one of the following: Birth Certificate , Marriage License/Divorce Decree,
or Legal Court Issued Document.
Note: Under special circumstances, other Government issued forms of identification( Federal/State Tax
Return, Tax Identification Number, Receipt of Social Security Application) can be used if your Social Security
card is not available.
Student Information
Name:
Student ID:
Last First M.I.
Address:
No. & Street State Zip Code
Phone:
City
Email:
