DMV Request Form

DMV Request Form

International Student Center

Phone: 909-652-6195

Email: international@chaffey.edu

Student Name*

First Name

Last Name

Chaffey Panther Email*

Please use your Panther email

Student ID Number*

Address: Have you updated your address on MyChaffeyView? If no, please do so prior to submitting this request. *

Address Line 1

Address Line 2

City

State

ZIP Code

Phone Number *

Semester*

Summer Fall Spring

Current Semester GPA:*

Overall GPA:*

How many units are you registered in*

Have you completed the placement process/assessment? *

Yes No

Have you completed International Student Orientation? *

Yes No

Have you created an education plan? *

Yes No

Do you have any Chaffey holds/restrictions?*

Yes No

If you have any Chaffey holds/restrictions, please list: *

Please write N/A if not applicable

Do you have medical insurance?*

Yes No

Have you completed a TB Test? *

Yes No

Signature*

Use your mouse or finger to draw your signature above

Date/Time*