Address Change Request
Office of the Registrar
Student ID (UTD ID or SSN):
______________________________________
Name on file:
Last First Middle Maiden
______________________________________________________________________________
Any other names used: Date of birth:
_____________________________________________ _____________________________
Email: Last Term Attended (ie Fall 2010):
_____________________________________________ _____________________________
Mailing __ SEVISChange Address to: Home __ ___
(Select the one you wish to change)
_____________________________________________________________________ _____
Street Apt/Unit
______ ___________________________________________ ____________ _____
City State Zip Code
_________________________________________________________ _________________
Student Signature Date
Please send completed request to the Office of the Registrar
Fax: 972-883-6335
Email:
records@utdallas.edu
Mail:
The University of Texas at Dallas
Office of the Registrar
800 W. Campbell Rd., ROC 13
Richardson, TX 75080-0321
Security Statement: Your UTD ID/SSN is being requested because it is a
unique ID which is maintained for the purpose of accuracy in tracing information. The disclosure of
such information is voluntary. Disclose for your UTD ID/SSN is governed by the Public Information Act
(Chapter 552 of the Texas Government Code)
click to sign
signature
click to edit
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