CHANGE OF STUDENT OF NAME AND ADDRESS
 

ID#

NAME:    Last    First    Middle

CHANGE OF ADDRESS:                                                   

Street/RR/Box:                                Permanent Address Temporary Address Prime Address

City:                       State:  AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY     ZIP Code:   

New Home Phone Number:              

Cell Number:              

** Is this also a new address for your next of kin?    Yes    No     Permanent Address Temporary Address Prime Address

** Is this also a new phone number for your family?  Yes    No  
    If no, please list new phone number:      
 

Names of Next of Kin:  Last    First    Middle

                                  Last    First    Middle

CHANGE OF NAME & NEXT OF KIN (if applicable):

New Legal Name:        Last    First   Middle

New Next of Kin:         Last    First   Middle

Relationship:    Parent Child Husband Wife

Effective Date:

STUDENT’S SIGNATURE _____________________________________ DATE ___/___/___

Please print out the completed form, sign it and return it to:

Office of the Registrar
Huntington University
2303 College Avenue
Huntington, IN 46750
Fax (260) 359-4086