California State University, Bakersfield | Office of Admissions and Records 9001 Stockdale Highway | Bakersfield, CA | 93311-1022 (661) 654-3036 | Fax: (661) 654-3389 Date: ________________ CSUB ID #: _______________________ Name (currently on records): ________________________________________ (Last) (First) M.I. Please make the following changes on my records: Corrected Social Security No: _________-______-___________ New Name: _____________________________________________________________ (as to appear (Last) (First) M.I. on records) New Address: ____________________________________ _____________________ Street Apt. __________________________________ ______________ ___________________ City State Zip Date of Birth: ___________________________ New Telephone #: ( ) ________________________________ Email Address (not CSUB RunnerMail account): _____________________________ Change user name on CSUB RunnerMail with new first and last names. I am an International Student. Please update my SEVIS record to reflect this

change. Check this box if you wish to have a “Permanent Address” on file which differs from

your mailing address. Mail from campus will not be sent to this address. Complete information below.

Address: ________________________________________________________________________ Street Apt. _______________________________________________________________________ City State Zip Telephone #: ( ) _______________________________ Signature: _______________________________________ Date: ___________________________________________

BIODATA REVISION FORM

Entered by: ______________ Date: ___________________

OFFICE USE ONLY