STUDENT UPDATE FORM

Student Name:*
Please select which information you would like to update:*

NAME CHANGE CORRECTION

Legal Name and/or Chosen Name Change

Name Change Correction Type:*
Former Legal Name:*
New Legal 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

 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:*
Optional:

Acknowledgment

Use your mouse or finger to draw your signature above
Date/Time*

Admissions & Records

Student has provided required documentation*
Checkbox
Please select your assigned alpha grouping *
Form secured by Formstack
Form secured by Formstack
Powered by Formstack Create your own form