GENERAL INFORMATION
To change your address, you may log on to BannerWeb at http://www.my.ltu.edu and change your address
online, or you may complete and submit this form.
To change your name, you can complete and submit this form, along with official documentation of your name
change. Official documentation includes a marriage license or court order.
STUDENT INFORMATION
Name LTU ID#
Are you an international student on a student visa? No Yes SEVIS ID:_________________
ADDRESS CHANGE:
New Address:
Street Apt.
City _____________State ZIP__
Phone Number _________
Type of Address: Permanent Mailing International Accounts Payable
NON-LTU EMAIL INFORMATION: additional e-mail that the university may use to contact you. Please
remember, the LTU e-mail is the OFFICIAL method of communication and you should ALWAYS check your LTU
e-mail. Failure to do so may result in your missing important information about deadlines or changes in policy.
Email Address _________
NAME CHANGE (remember that official documentation must be submitted):
New Name:
First Middle ______Last__________
AUTHORIZATIONS
Student Signature (authorizes the name and/or address change) Date
*Handwritten Signature Required
