UPDATED: June 13, 2019
Request for Student Record Change
To provide students the opportunity to change their record (name, social security number, student type, catalog
year, or program of study) on file with the Registrar’s Office. Students wanting to change their mailing address,
email, or phone number, should do so through LoLa. (Related Policy: Catalog Year, found in the 2019-2020
Catalog and referenced below)
Student Information: (Please Print Clearly)
NAME ______________________________________ LOLA # __________________
PHONE _______________________ E-mail ________________________________
CURRENT DEGREE PROGRAM: _____________________________________________________________________
Type of Record Change Being Requested (select all that apply):
Name Change Social Security Number Student Type
Catalog Year Program of Study
Name Change: Attach official documentation- marriage certificate, divorce decree, or court order and
photo identification
From: _______________________________________ To: _________________________________________
Last First Middle Last First Middle
Reason for Change of Name: Married Divorced Other
Change of SSN: Attach official documentation- State ID or Passport, or Social Security card and Photo
From: __________________________ To: ________________________
UPDATED: June 13, 2019
Program of Study Change: to change your program of study, check the program of study you want to
change to (and concentration where applicable) below
Program of Study
Gonzales Campus
Reserve Campus
Westside Campus
AC & Refrig: Commercial
Business Office Administration
Drafting & Design Tech
Elec Helper: Commercial/Industrial
General Studies
Industrial Instrumentation Tech
Industrial Maintenance Tech
Medical Assistant
Medical Coding Specialist
Patient Care Technician
Pipefitter Apprentice
Practical Nursing
Process Technology
Teaching (Grades 1-5)
Louisiana Transfer-Associate of Art
Criminal Justice
Social Sciences
Louisiana Transfer-Associate of Sci Biological Sciences Physical Sciences
Associate of General Studies
Arts & Humanities
Computer Science
Natural Sci/Math
Social Behavioral Science
General Business
Catalog Year Change:
I am requesting a change of Catalog from: ____________ (Academic Year) to: ___________ (Academic Year)
to be used to meet program requirements for graduation. I have met with an advisor and understand the graduation
UPDATED: June 13, 2019
NOTE: Catalog year determines the set of academic requirements that must be fulfilled for graduation. A student
will graduate under the catalog in effect at the time of initial enrollment as a degree-seeking student at RPCC.
This catalog may continue to be used by the student provided enrollment is not interrupted for two consecutive
regular semesters (i.e., fall and spring). A student whose enrollment is interrupted for two or more consecutive
regular semesters may choose no catalog earlier than the one in force at the time of re-entry. Students may also
choose to move into a newer catalog year if desired. RPCC will make a reasonable effort to honor the curricular
requirements in the chosen issue of the catalog. However, because courses and programs are sometimes
discontinued, RPCC shall make the final determination as to whether or not degree requirements are met.
Student Type Change:
Are you enrolled in high school Yes No
Did you graduate from high school Yes No
Have you ever attended this college Yes No
Have you ever attended any other college Yes No
*If yes, were you enrolled in high school at the time? Yes No
Are you currently seeking a degree at another college and plan to return to that college next semester?
Yes No
Additional notes for any of the above requests:
Routing Instructions
Completed forms must be hand delivered by the student making the request to the Student Services Office at the
Gonzales, Reserve, or Westside Campus. In order for the form to be processed, an RPCC staff member must
verify that the person delivering the form is the student requesting the record change. A government-authorized
photo ID is required.
For Office Use Only:
ate Received: __________________ Photo ID Verified By: _________________________