Student Information Change Form

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Mark the change(s) you are requesting:

A valid picture ID is required when making any student information changes.

Please note (*) indicates required fields.

Type of Address Change:*

Mailing Address Change Permanent Address Change

Gender/Pronoun/Sex Designation*

Gender Change Sex Designation Change Pronoun Change

Name*

First Name

Middle Name (optional)

Last Name

Student ID Number

Email*

Confirm Email *

Mailing Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Permanent Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Birth Date Change*

Valid ID displaying correct date of birth or birth certificate is required

Supporting Date of Birth Change File*

No File Chosen

File uploads may not work on some mobile devices.

Birth Certificate, California ID, California Driver's License

Change Preferred Email to:*

Confirm Change Preferred Email to: *

Delete current preferred e-mail address on file?*

Yes No

How would you describe yourself?*

Female Male Tran Female/Trans Woman Trans Male/Trans Man Genderqueer or Gender Non-conforming Nonbinary Gender Declined to state Different Identity (Please Specify)

What sex were you assigned at birth, such as on an original birth certificate?*

Female Male Nonbinary Decline to State

Pronoun Change*

She, Her, Hers He, Him, His They, Them, Theirs Ze, Hir

Major Change*

Associate in Science Associate in Arts Associate in Arts for Transfer Associate in Science for Transfer Certificate

Change Major for Term*

Associate in Arts*

Associate in Science*

Associate in Arts for Transfer*

Associate in Science for Transfer*

Certificates*

Education Pattern*

IGETC CSU IGETC UC CSU FC AA/AS

Education Pattern*

IGETC CSU IGETC UC CSU

Legal Name Change*

First Name

Middle Name (optional)

Last Name

Your legal name will be presented on your official transcript and enrollment verifications. For more information on how your legal name is presented on Fullerton College records, please visit https://admissions.fullcoll.edu/chosen-name-gender/.

Chosen/Preferred First Name Change:*

Chosen/preferred name is the name that a student wishes to be known or identified by which is different from their legal name. Chosen/preferred name will appear on campus rosters, Canvas, diplomas, and other platforms. For more information on how your chosen/preferred name is presented, please visit https://admissions.fullcoll.edu/chosen-name-gender/.

Cell Phone

Home Phone

Work Phone

Social Security Number Change*

Upload below a copy of your Social Security card

Social Security Card*

No File Chosen

File uploads may not work on some mobile devices.

Social Security Number Verification*

Upload below a copy of your Social Security card

Social Security Card*

No File Chosen

File uploads may not work on some mobile devices.

Supporting Legal Name Change File*

No File Chosen

File uploads may not work on some mobile devices.

Legal document such as marriage certificate, court document, California ID, California driver’s license, SSN card, passport

Identification Card*

No File Chosen

File uploads may not work on some mobile devices.

Driver's license, passport, California ID, student ID

Your identification card is used to verify your identity as a student. Your ID card should reflect your legal name, however, does not need to reflect the student information change you are requesting.

Sex Designation Change File*

No File Chosen

File uploads may not work on some mobile devices.

Legal documents such as marriage certificate, California ID, passport, or court documents

W-9S Request for Student's or Borrower's Taxpayer Identification Number and Certification*

No File Chosen

File uploads may not work on some mobile devices.

Signature*

[clear]

Use your mouse or finger to draw your signature above

Office Use

Form completed by*

Date/Time

Cancel Request*

No Yes

Notes to Student*