Address Change Form

Complete the form below to notify the Registrar's Office of your address change.

Month

Day

Year

Effective Date

Student ID#

Last Name

First Name

Middle Initial

Telephone

Email Address

Permanent

Local

Check appropriate box

Number and Street Address, (Apartment if applicable)

City

State

Zip

Permanent

Local

Check appropriate box for additional address

Number and Street Address (Apartment if applicable)

City

State

Zip

Former address being changed

Submit

CONTACT

Registrar's Office

Keller Hall
300 College Park
Dayton 45469 - 2772

937-229-4187
Email