Ventura County Community College District
MOORPARK COLLEGE ● OXNARD COLLEGE ● VENTURA COLLEGE
www.moorparkcollege.edu www.oxnardcollege.edu www.venturacollege.edu
REQUEST TO CHANGE PERSONAL INFORMATION
(Photo ID and Documentation Required)
Student Name ___________________________________________________________________
Last First Middle
Student ID # ___________________________ Phone No. ( ) __________________
________________________________________________________________________________________
CHANGE OF SOCIAL SECURITY NUMBER/TAXPAYER ID NUMBER (Provide social security
or TIN card/documentation)
Old Social Security Number __________________ New Social Security Number ____________________
STAFF ONLY: SSN card ___ TIN card ___ Other___
________________________________________________________________________________________
CHANGE OF ADDRESS (Provide picture ID card that verifies address)
Old Legal Address: ____________________________________________________________________
Number/Street City State Zip
New Legal Address: ____________________________________________________________________
Number/Street City State Zip
New Mailing Address (if different from legal address):
_______________________________________________________________________________________
Number/Street City State Zip
________________________________________________________________________________________
CHANGE OF NAME (Provide picture ID that verifies new name)
Old Name:____________________________ New Name:_________________________________
Reason for change: ______________________________________________________
________________________________________________________________________________________
CHANGE OF PERSONAL EMAIL ADDRESS(NOTE: College emails will only be sent to your “@my.vcccd.edu”
email)
Old Email:______________________ New Email:__________________________________________
________________________________________________________________________________________
Request for Student’s Taxpayer Identification Number (Select one)
□ I am a foreign national/nonresident alien and do not have a Social Security number or individual taxpayer identification
number. I do not plan to file an income tax return in the U.S.
□ I do not wish to provide my taxpayer identification number to Oxnard College at this time. I understand that I may be
subject to an IRS fine of $50 for failure to do so. I further understand that the IRS will not be able to use the Form 1098-T
filed by Oxnard College to confirm my eligibility for certain education tax benefits without my taxpayer identification
number.
_____________________________________________________________________________________
I certify under penalty of perjury that the information provided above is true and accurate to the best of my
knowledge.
Student Signature ____________________________ Date ___________________________
