Student Update Form (Workflow)

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STUDENT UPDATE FORM

Student Name:*

First Name

Last Name

Chaffey ID:*

Chaffey Email Address (if available):*

Please select which information you would like to update:*

Name Change Correction Social Security Update Date of Birth Correction Miscellaneous Update

NAME CHANGE CORRECTION

Legal Name and/or Chosen Name Change

Name Change Correction Type:*

Legal Name Change Chosen First Name

Former Legal Name:*

First Name

Middle Name (optional)

Last Name

New Legal Name: *

First Name

Middle Name (optional)

Last Name

1. Please upload your SSN. NOTE: Please ensure your SSN is signed.

No File Chosen

File uploads may not work on some mobile devices.

Required for legal name corrections.

2. Please upload your Driver's License. NOTE: Passport & State ID are also acceptable.

No File Chosen

File uploads may not work on some mobile devices.

Required for legal name corrections.

Chosen First Name:

SOCIAL SECURITY CORRECTION

Social Security Number Correction

Incorrect Social Security Number:*

Correct Social Security Number:*

1. Please upload your SSN. NOTE: Please ensure your SSN is signed.

No File Chosen

File uploads may not work on some mobile devices.

Required for SSN corrections.

2. Please upload your Driver's License. NOTE: Passport, State ID, High School ID are also acceptable.

No File Chosen

File uploads may not work on some mobile devices.

Required for SSN corrections.

DATE OF BIRTH CORRECTION

Date of Birth Correction

Incorrect Date of Birth:*

Correct Date of Birth:*

1. Please upload your Driver's License. NOTE: Passport & State ID are also acceptable.

No File Chosen

File uploads may not work on some mobile devices.

Required for DOB corrections.

MISC UPDATE

Miscellaneous Information Corrections

PLEASE NOTE: You may change your mailing address, phone number, or email address in the MyChaffey portal

Miscellaneous Update Type:*

Address Phone Number Program of Study Other Check All

Address:*

Address Line 1

Address Line 2

City

State

ZIP Code

Phone Number:*

Program of Study:*

Other:*

Optional:

I DO NOT WANT MY DIRECTORY INFORMATION RELEASED TO ANYONE.

Acknowledgment

Student Signature:*

[clear]

Use your mouse or finger to draw your signature above

Date/Time*

Admissions & Records

Student has provided required documentation*

Yes No

Checkbox

Program of Study Major Code Missing SSN Card Missing Signature SSN Card Missing Photo ID Missing

Other:

Please select your assigned alpha grouping *

A-Z Backup

Employee Email*