Office of Records and Registration
640 Bay Road, Queensbury, NY 12804-1445
CALL: 518.743.2279 | FAX: 518.832.7601 | EMAIL: registrar@sunyacc.edu
Page 1 of 1 Updated 7/16/19
Change of Address Form
Address changes are preferably made via the students Self-Service Banner account by logging in and selecting Personal Information
then Update Addresses and Phones.
If a student is unable to utilize their Self-Service Banner account, the student can change their address by completing this form and
submitting it to the Office of Records and Registration in Warren Hall.
In order for an address change to be made with this form, the student must provide government issued identification when submitting
this form.
General Person Information
Banner ID: _____________________________________
Student Name (Please print): _____________________________________________________________________________________
First Middle Last
Select one or both to be updated. You are required to have a Permanent Address on file.
❑ New Temporary Address:
_______________________________________________________________________________________________________________
Street
_______________________________________________________________________________________________________________
City State Zip
❑ New Permanent Address:
_______________________________________________________________________________________________________________
Street
_______________________________________________________________________________________________________________
City State Zip
Cell Phone (including area code): __________________________ Other Phone: ________________________________________
Email Address: ______________________________________________________________________________________________________
All College Communications will be sent to the students Adirondack Wolfmail email address while enrolled.
I certify that the information provided on this address change form is correct. I understand that once this information is updated in the
student records system, mail and all College communications will now be sent to my updated address.
Student Signature: _____________________________________________ Date: ____________________________________
For Registrar Use Only: Initials: _________________________ Date: _________________________
Additional Notes:
