Grant Record Chang Grant Record Change Form For Students Or Students Cal Grant Program Page 2
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1
2Instructions for Completing the Grant Record Chang
Instructions for Completing the Grant Record Chang
e F
e F
orm for Students
orm for Students
Instructions for Completing the Grant Record Chang
Instructions for Completing the Grant Record Chang
Instructions for Completing the Grant Record Change F
e F
e Form for Students
orm for Students
orm for Students
Section 1 — Student Information (This section and Section 4 must be completed)
Section 1 — Student Information (This section and Section 4 must be completed)
Section 1 — Student Information (This section and Section 4 must be completed)
Section 1 — Student Information (This section and Section 4 must be completed)
Section 1 — Student Information (This section and Section 4 must be completed)
1.
Enter your name (current last, first, middle initial). If you indicated a name change in question #1, please provide your
pr pr pr pr previous
evious
evious
evious name (last, first, middle initial) in the shaded box. Remember to print or type clearly.
evious
2.
Enter your social security number. If your social security number is a change from Commission records, enter your
correct number and attach a copy of your social security card.
3.
Enter your date of birth (month, day, year).
4.
Enter your telephone number, including area code.
5.
Check “Yes” if your address is different from the Commission’s records. Check “No” if your address is the same as the
Commission’s records. Enter your street address, city, state and five- or nine-digit zip code.
Section 2 — School Chang
Section 2 — School Chang
Section 2 — School Change e e e e
Section 2 — School Chang
Section 2 — School Chang
6.
If you wish to change your school of attendance, enter the school’s name, city and date effective. A chang
A chang
A change in school
A chang
e in school
e in school
e in school
A chang
e in school
choice may effect your eligibility for an aw
choice may effect your eligibility for an aw
ard.
ard.
choice may effect your eligibility for an aw
choice may effect your eligibility for an aw
choice may effect your eligibility for an award.
ard.
ard.
7a.
Enter the term the change in school choice is effective.
b.
Check whether you will live on campus, off campus, or at home with parents or relatives.
Section 3 — Leav
Section 3 — Leav
e of Absence Request
e of Absence Request
Section 3 — Leav
Section 3 — Leav
Section 3 — Leave of Absence Request
e of Absence Request
e of Absence Request
8.
Enter the school you attend or have attended most recently and the date and term you last attended (e.g. 12/05, Winter
2005). Also enter the terms for which you are requesting a leave of absence (e.g. Fall semester), and the exact date for
which you are requesting a leave of absence (e.g. 9/15/05 to 12/15/05).
9.
Print or type the reason(s) for your leave of absence request.
Section 4 — Student Signatur
Section 4 — Student Signatur
Section 4 — Student Signatur
Section 4 — Student Signatur
Section 4 — Student Signature (T
e (T
e (T
e (T
e (To av
o av
o av
o av
o avoid delays, sign, date, and mail or fax this form as soon as possible.)
oid delays, sign, date, and mail or fax this form as soon as possible.)
oid delays, sign, date, and mail or fax this form as soon as possible.)
oid delays, sign, date, and mail or fax this form as soon as possible.)
oid delays, sign, date, and mail or fax this form as soon as possible.)
10.
Your signature certifies to the best of your knowledge that this information is true and correct.
Pr Pr Pr Pr Providing false information may r
oviding false information may r
oviding false information may r
oviding false information may r
oviding false information may result in the withdraw
esult in the withdraw
esult in the withdraw
esult in the withdraw
esult in the withdrawal of your aw
al of your aw
al of your aw
al of your aw
al of your award.
ard.
ard.
ard.
ard.
If you have any questions concerning this form, you may contact the Commission’s Customer Service Branch
by calling (888) 224-7268 or, via e-mail at custsvcs@csac.ca.gov. Our office hours are 8:00 a.m. to 4:50
p.m., Monday through Friday, except Thursday. Office hours on Thursdays are 9:00 a.m.to 4:50 p.m.
You may fax a copy of the form to (916) 526-8002 or mail your form to:
California Student Aid Commission
California Student Aid Commission
California Student Aid Commission
California Student Aid Commission
California Student Aid Commission
Grant Pr
Grant Pr
Grant Pr
Grant Pr
Grant Pro o o o o g g g g g ram Pr
ram Pr
ram Pr
ram Pr
ram Processing Section
ocessing Section
ocessing Section
ocessing Section
ocessing Section
P P P P P .O. Box 419028
.O. Box 419028
.O. Box 419028
.O. Box 419028
.O. Box 419028
Rancho Cordov
Rancho Cordov
a CA 95741-9028
a CA 95741-9028
Rancho Cordov
Rancho Cordov
Rancho Cordova CA 95741-9028
a CA 95741-9028
a CA 95741-9028
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