Student Information Change Form

Student Information Change Request

Mission College

Admissions & Records Office

Questions? please contact the Admissions & Records Office.

Student Contact Information

Mission College ID*

example: G01234567

Name on FIle*

First Name

Middle Name (optional)

Last Name

Personal Email Currently on File*

@gmail.com, @yahoo.com

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Sample forms of acceptable ID:

High school or College ID
Government issued ID (CA ID, CADL, Passport, Employment Authorization Cards)
Government issued ID from another country

Upload Photo ID* No File Chosen

File uploads may not work on some mobile devices.

Select items that need to be Changed, Corrected or Updated*

Name Email Phone Number Address Social Security Date of Birth

Updated Personal Email

Updated Phone Number

Updated Address

Address Line 1

Address Line 2

City

State

ZIP Code

Name Change Requested

A request to update your legal name must be made by completing this form and submitting two forms of supporting documentation. One form of documentation must display your new name and the other must display your prior name.

Acceptable supporting documentation includes:

Birth Certificate
California Driver License
Court Order Name Change Document
Marriage License
Passport (required for F-1 visa students)
Permanent Resident Card
State Issued Identification Card

Updated Legal Name*

First Name

Middle Name

Last Name

Upload 2 Forms of Supporting Documentation* No File Chosen

File uploads may not work on some mobile devices.

Additional File Upload No File Chosen

File uploads may not work on some mobile devices.

Social Security Correction Request

A request to update your Social Security Number must be made by submitting this form, your Social Security Card and one additional form of supporting documentation.

Acceptable supporting documentation includes:

Social Security Card (Required)
Government issued ID
Pay stub
Tax cover sheet
W-2

Corrected Social Security Number*

Upload Official Social Security Card & Additional Document* No File Chosen

File uploads may not work on some mobile devices.

Additional File Upload No File Chosen

File uploads may not work on some mobile devices.

Date of Birth Correction Request

A request to correct you Date of Birth must be made by submitting this form, your Certificate of Birth and one additional form of supporting documentation.

Acceptable supporting documentation includes:

Official Certificate of Birth
U.S. Passport
Government issued ID

Corrected Date of Birth*

Upload Official Certificate of Birth & Additional Document* No File Chosen

File uploads may not work on some mobile devices.

Additional File Upload No File Chosen

File uploads may not work on some mobile devices.

Signatures & Authorization

By submitting this form, I declare under penalty of perjury that the statements and information submitted on this form are true and correct. I understand that all materials submitted by me for the purposes of maintaining my record become the property of the West Valley-Mission Community College District. I also understand that falsification, withholding pertinent data or failure to report changes to my educational status may result in District action.*

Student Name (type your name to confirm agreement to these terms).**

Comments or Questions: