Change of Address Form
Mail or fax the form to the Registrar's Office.
Registrar's Office
501 Crescent Street
New Haven, CT 06515-1355
Phone: 203-392-5301
Fax: 203-392-7144
www.southernct.edu/registrar
Student Information
Please select your current Degree level:
Undergraduate
Graduate
Not a current student
Name (Last, First, Middle):
Student ID Number:
Last four digits of SSN:
Date of Birth (mm/dd/yyyy):
Phone Number:
E-mail Address:
New Address Information
Street Address:
City:
State:
Zip Code:
Country if applicable:
Signature:
Date:
Registrar
s Office Use Only
Processed By/Date:
Rev. 5/10/16
click to sign
signature
click to edit
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome