CHANGE OF ADDRESS FORM
If you are a permanent employee, please contact Human Resource Services to change your addresses.
NAME:
T NBR: T
(LAST) (FIRST) (MI)
(PR) Permanent Address This address must match your Residency Status. If you are an Out-of-State student, this address
must remain an Out-of-State address. If you are an In-State student, this address must remain a
Tennessee address.
New (PR) Address:
(STREET) (CITY) (STATE) (ZIP) (PHONE)
(MA) Mailing Address The address where you wish to receive general mail. This address is also used by Human Resource
Services for W-2 tax information mailings.
New (MA) Address:
(STREET) (CITY) (STATE) (ZIP) (PHONE)
(LO) Local Address Indicates the local off-campus address.
New (LO) Address:
(STREET) (CITY) (STATE) (ZIP) (PHONE)
(BI) Billing Address This address is used by the Business Office for billing, enrollment confirmation, and financial
information.
New (BI) Address:
(STREET) (CITY) (STATE) (ZIP) (PHONE)
(PA) Parent Address This address is used to contact parent in case of emergency or to mail general campus activity
information to parents.
New (PA) Address:
(STREET) (CITY) (STATE) (ZIP) (PHONE)
INFORMATION RELEASE FLAGS
Do you want your directory information released to individuals, employers, media, etc? Yes No
TTU AFFILIATION:
Please check all affiliations that apply to you:
Permanent Employee Temporary Employee Adjunct Instructor Graduate Assistant
Student Worker Student Alumnus Vendor
Signature: ______________________________________________ Date: _________________________
