CHANGE OF ADDRESS FORM

CHANGE OF ADDRESS/CHANGE OF NAME FORM Date

ID #

Student’s Name

New Name (please submit a copy of your Social Security Card with your new name when returning this form)

New Address

Phone Number:

Please circle one: Permanent / Local / Both

Permanent_________________________Local____________________________

Student’s Signature ____________________________________________________________

Return to: Registrar’s Office

Business Office, Student’s Adviser, Office use only: Email Notification to: Business Office, Financial Aid, Student Development Student’s Advisor, Financial Aid, change. Student Development, IT Inform IT of name

Data Entered By_______________ Date Entered__________________