Office of International Student ServicesLiberty University, 1971 University Blvd., Lynchburg, VA 24515
Phone (434) 592-4118Fax (434)
Updated 2/16/2017
Address Reporting Form
for F-1 International Students
General Information: F-1 international students are required by U.S. law report their address to the Department of
Homeland Security (DHS). F-1 students changing his/her address, must report the change to his/her International Student
Advisor within 10 business days. This form will be used to update the student’s SEVIS record with DHS.
*** All F-1 International Students are required to notify their International Student Advisor within 10
days of a change of address or phone number. ***
Student Name: _______________________________________ Liberty ID #:_____________
Phone #: ______________________________________________
Please check here if you will live on campus.
(If you live off campus, please provide your complete address below.)
Street/PO box: __________________________________________
Apartment: _____________________________________________
City: __________________________________________________
State & Zip Code: _______________________________________
Parent/Guardian name:
Street/PO box: __________________________________________
Apartment: ____________________________________________
City: _______________________________________________
State/Province: _________________________________________
Country: ______________________________________________
Zip Code: _____________________________________________
Phone #: ______________________________________________
Email: ________________________________________________
Emergency Contact: This is the person we would call if you became ill or injured.
Name: ______________________________________________
Relationship: _________________________________________
Phone #: ____________________________________________
E-mail: ______________________________________________
Student Signature: ________________________________________ Date: _____/_____/_______
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