STUDENT UPDATE FORM
A valid form of photo ID is required to update any information.
Please Print – Use Black or Blue Ink Only
Student ID Number: ___________________________
Student Name _____________________________________________________________________________________
Last
First
MI
CHANGE OF ADDRESS, PHONE NUMBER, and/or E-MAIL
________________________________________
_________________________________
_______________
Street Address
City/State
Zip Code
Apt #
________________________________
____________________________
Home Phone Number (with area code)
Cell Phone Number (with area code)
___________________________________
E-Mail
CHANGE OF MAJOR
(See back of form for selection)
From: ______________________________________
To: ___________________________________
SOCIAL SECURITY NUMBER, NAME and/or DATE OF BIRTH CORRECTION
**Must present Social Security Card, Driver’s License, Marriage Certificate, Birth Certificate, or other
supporting document**
SOCIAL SECURITY NUMBER CORRECTION:
Incorrect Number _________- ________- ____________
Correct Number ________- __________- ____________
NAME CORRECTION:
YOU MUST NOTIFY YOUR INSTRUCTORS OF A NAME CHANGE IF YOU ARE
CURRENTLY ENROLLED IN CLASSES.
Previous Name ________________________________________________________________________________________
Last
First
MI
Current Name _________________________________________________________________________________________
Last
DATE OF BIRTH CORRECTION:

First
MI
Incorrect DOB ____/____/____ Correct DOB ____/____/____
I DO NOT WANT MY DIRECTORY INFORMATION RELEASED TO ANYONE.
Student Signature _________________________________________________ Date ___________________
OFFICE USE ONLY
Received in Admissions on: _________________
Processed By: __________________
(Revised on 09/19/12
MAJORS AND ACADEMIC PROGRAMS
MAJOR/ACADEMIC PROGRAMS: Select One
MAJORS
CODES
MAJORS
CODES
OH.AS
AUTO.AS
BUS.AS
BUSAD.AS
BET.AS
BRE.AS
CLDEV.AS
CIS.AS
CIDG.AS
CONST.AS
Environmental Horticulture – Agriculture
and Natural Resources Horticulture
Fine Arts
Fire Technology
Liberal Arts- Mathematics and Science
Liberal Arts- Arts/Humanities
Liberal Arts- Social/Behavioral Science
Math and Science
Medical Assistant
Nursing
Paramedic
ELCT.AS
ELENC.AS
Restaurant Management
Respiratory Therapy
RM.AS
RT.AS
ELTCE.AS
Welding
WELD.AS
Administration of Justice
AJ.AS
Automotive Technology
Business
Business Administration
Business Education Technology
Business Real Estate and Escrow
Child Development
Computer Information Systems
Comp Integrated Design and Graphics
Construction and Manufacturing
Technology
Electronics and Computer Technology
Electronics Engineering Technology
▪ Computer Emphasis
Electronics Engineering Technology
▪ Electronics Emphasis
Associate in Science for Transfer in
Administration of Justice
Associate in Science for Transfer in
Mathematics
Associate in Arts for Transfer in Sociology
AJT.AS
MASCT.AS
SOCT.AA
FINE.AA
FT.AS
LAMS.AA
LAAH.AA
LASBS.AA
MASC.AS
MA.AS
NURS.AS
PARA.AS