HONOLULU COMMUNITY COLLEGE
RECORDS OFFICE
CHANGE OF ADDRESS FORM
NAME:_________________________________BannerID/SSN:_____________
Print Last Name, First Name, MI
NEW LOCAL Mailing Address
No Changes
Change – fill out below
___________________________________________________________
Number Street Apt. No.
___________________________________________________________
City State Zip Code
NEW PERMANENT Address
Same as Above
No Changes
Change – fill out below
___________________________________________________________
Number Street Apt. No.
___________________________________________________________
City State Zip Code
NEW Telephone Number
Current Number: ____________________
Work Number:________________________
Other:______________________________ Specify: _______________
Please change my records to reflect the change(s) requested
above.
________________________________________________________________
Student’s Signature Date
Records rev. 1/04
