Ohlone College Student Information Change Form printable pdf download

For Office Use Only:

STUDENT INFORMATION CHANGE FORM

Request Received:

Admissions & Records Office (Building 7, Second Floor)

Staff:____________ Date:__________

43600 Mission Blvd., Fremont, CA 94539

Record Updated:

Fax #: (510) 659-7321 or scan to

admissions@ohlone.edu

Staff: ____________ Date:___________

Photo ID is required when submitting this form. Incomplete or unsigned forms will not be

processed. Social Security card must be shown when making name and social security changes.

Proof of legal name change required. This form cannot be used to request a change of residency status.

Please list all current information here:

Student ID # or Social Security #:

_________________________________________________

Birthdate: ___________________________

Full Name:

______________________________________________________________________

Phone (Home):_______________________

Last

First

M.I.

Email: _________________________________________________________

Address changes: Please use WebAdvisor

Student’s Signature:

_______________________________________________________

Date: ___________________________

Please indicate which information needs to be corrected, updated, or changed:

Name (indicate previous):__________________________________________

Social Security/ ID# (indicate error):__________________________________

Birthdate: ______________________________________________________

2013