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 (Preferred Name)

Legal Name Change Type*

First Name Last Name

Please be prepared to upload the following documents.

Copy of social security card.
Copy of driver's license, state ID, or passport.
Copy of court decree (court order) with your updated name.

Please be prepared to upload the following documents.

Copy of social security card.
Copy of driver's license, state ID, or passport.

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.

3. Please upload a copy of your court decree (court order) with your new name.

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

Please be prepared to upload the following documents.

Copy of social security card.
Copy of driver's license, state ID, high school ID, or passport.

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

Please be prepared to upload the following documents.

Copy of driver's license, state ID, or passport.

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:*

Please provide your major code below. If you need assistance locating your major code, contact our Counseling Department for further assistance.

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*