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Address Update and Emergency Contact

NOTE: You MUST correctly type in your student ID. Otherwise, your request will not be able to be processed.  Birth date is requested for confirmation of identity.

Student ID (without punctuation):
  (e.g. 123456789 is correct; 123-45-6789 is NOT correct). If your ID begins with an M, enter an upper case M plus the remaining eight digits: e.g. M00012345
Birth date (MMDDYYYY-without punctuation):
  (e.g. 07011979 is correct; 7/1/79 is NOT correct)
First Name: NOTE:  Name changes cannot be processed via web requests.
Middle Initial: Official document supporting name change is required and must be submitted to the Registrar's Office.
Last Name: Examples include:  photocopy of Social Security card, court decree, etc.
Email Address:
  (optional: this will only be used to contact you if a problem or question arises)

To change your LOCAL ADDRESS, please provide complete information. NOTE: if you have moved from one room in a Residential Hall on campus to another room on campus, you do NOT need to fill out this form.
 
 
Dates From:
Address Line 1:
Address Line 2:
City, State, ZIP:
   
Phone  Number:
Check here if unlisted:
Check here if a cell phone:

Please indicate the type of housing status you specified above (required for local address):
  I live with parent/guardian
  I live in an apartment or home, not with parent/guardians

To change your HOME ADDRESS, please provide complete information. NOTE: students employed on campus must inform the Student Payroll Office of address change.
 
 
Address Line 1:
Address Line 2:
City, State, ZIP:
Country (other than USA):
   
Phone  Number:
Check here if unlisted:

To add or change your EMERGENCY CONTACT, please provide complete information.
 
 
This is:
 a new record a change to an existing record
Emergency Name:
Relationship:
Address Line 1:
Address Line 2:
City, State, ZIP:
Country (other than USA):
   
Daytime Phone Number:
Check here if daytime number is unlisted:
   
Evening Phone Number:
Check here if evening number is unlisted:

 

Thank you for helping us maintain current, accurate information
for your records!

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