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NAME CHANGE REQUEST
Student Information
section
Name as it currently appears in COD records:
Last Name
*
field type single line
Input blocked. Maximum character limit of 4000 characters reached.
First Name
*
field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Middle Name
field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Student ID
*
field type single line
Must be 7 digits. Example 0123456
Input blocked. Maximum character limit of 4000 characters reached.
College Email
*
field type single line
example@mycod.us
Input blocked. Maximum character limit of 4000 characters reached.
NAME CHANGE request must be submitted with one of the following:
section
Select at least one
*
field type checkbox
Scan supporting documentation and save is an allowed format (JPEG, PDF, TIFF). Use the Supporting Documents Upload in the A&R Forms menu on the Student Portal to submit.
Select at least one
Copy of California Driver License or California ID Card issued showing your new name. (Enlarge and lighten copy so it is easier to read)
Copy of Social Security Card issued to your new name. (Enlarge copy so it is easier to read)
A legal, court filed document showing your new name such as marriage license or divorce decree.
Three documents providing common usage of the name to which you are requesting a change such as utility bills, rental agreement, bank account statement, driver's license from another state, organization membership card, etc.
Change my name to:
section
Last Name
*
field type single line
Input blocked. Maximum character limit of 4000 characters reached.
First Name
*
field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Middle Name
field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Your Web Advisor user name will not change. Change to Web Advisor must be requested in person at the A&R Counter.
Student Declaration
section
I AGREE
*
field type checkbox
I AGREE
I hereby certify that the information provided in this form is true and accurate.
Student Full Name
*
field type single line
This Constitutes as e-signature.
Input blocked. Maximum character limit of 4000 characters reached.
Date
*
field type date
Please allow up to 10 business days for processing.
Spam capture please leave empty