New Submission

Student Information

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 Namefield type single line
Input blocked. Maximum character limit of 4000 characters reached.
Student ID Number*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.
Daytime telephone number*field type single line
Input blocked. Maximum character limit of 4000 characters reached.

SSN to be added to student record*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Please explain*field type radio button
Explain why College of the Desert does not have your Social Security Number:
Please explainI did not provide my Social Security Number when I applied to the College but I wish to add it now.Other: Please Explain

Social Security Number currently on student record.field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Correct Social Security Numberfield type single line
Input blocked. Maximum character limit of 4000 characters reached.
Please check all that apply.field type checkbox
Check one and attach a statement that describes why College of the Desert has an incorrect Social Security Number.
Please check all that apply.I mistakenly transposed numbers and provided a wrong Social Security Number on my application.I made up the Social Security Number I provided on my application.I used my friend/relative Social Security Number.A friend/relative used my SSN instead of their SSN when they applied. This person will need to provide proof of SSN and statement of coursework which is their correct record.Other: Please Explain

*Complete Part-B above and/or attach a statement of explanation.

*Duplicate ID Numberfield type single line
Input blocked. Maximum character limit of 4000 characters reached.
SSN attached to this ID Numberfield type single line
Input blocked. Maximum character limit of 4000 characters reached.
*Triplicate ID Numberfield type single line
Input blocked. Maximum character limit of 4000 characters reached.
SSN attached to this ID Numberfield type single line
Input blocked. Maximum character limit of 4000 characters reached.
Please check all that apply.field type checkbox
Check one and attach a statement that describes why College of the Desert has an incorrect Social Security Number.
Please check all that apply.I mistakenly transposed numbers and provided a wrong Social Security Number on my application.I made up the Social Security Number I provided on my application.I used my friend/relative Social Security Number.A friend/relative used my SSN instead of their SSN when they applied. This person will need to provide proof of SSN and statement of coursework which is their correct record.Other: Please Explain

Use the Upload Portal to submit the following documents. Requests submitted without these documents will be automatically denied.
1. Valid Photo ID
2. Social Security Card

Student Initial*field type single line
I certify under penalty of perjury that all information I have given on this form is true and accurate. I understand it is my responsibility to monitor my college email account for results of this request.
Input blocked. Maximum character limit of 2 characters reached.
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
You must provide legible copies of your photo ID and Social Security Card. Other information may also be required. Scan supporting documentation and save in allowed format (JPEG, PDF, TIFF). Submit using the Supporting Documents Upload in the A&R Forms menu on the student portal.