Student Address Update Form
Office of the Registrar
Select as applicable:
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Student
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Faculty/Staff
PLEASE PRINT
Student ID number ____________________________________________________________________________________
Last name ______________________________________ First _______________________ Middle ___________________
P HOME/PERMANENT ADDRESS
Check if applicable:
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My HOME/PERMANENT ADDRESS is my preferred mailing address.
n
I am a GRADUATION APPLICANT and I would like my diploma sent to this address.
If this is also your residence address, you are not required to complete the LOCAL address portion of this form.
Street / P.O. Box _______________________________________________________________________________________________
City _____________________________________________________ State _________________ Zip code ______________________
Telephones: Home ( ____________ ) ___________________________ Cell ( ____________ ) ________________________________
P EMERGENCY CONTACT INFORMATION Select one:
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Parent
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Guardian
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Spouse
Name ________________________________________________________________________________________________________
Street / P.O. Box ________________________________________________________________________________________________
City _____________________________________________________ State _________________ Zip code ______________________
Foreign country (if applicable) _____________________________________________________________________________________
Telephone: Day ( ____________ ) ______________________________ Evening ( __________ ) _______________________________
P STUDENT’S SIGNATURE _________________________________________________ DATE ________________
Office of the Registrar • Coastal Carolina University • P.O. Box 261954 • Conway, SC 29528-6054 • 843-349-2019 • 843-349-2909 fax
Office Use Only: Entry by __________________ Date ___________________
Office of the Registrar • 8/11
• It is the obligation of every student to notify the Office of the Registrar of any change in address.
• Completing this form will not result in mail being forwarded by the U.S. Postal Service.
A separate change of address must be filed with the U.S. Postal Service.
• Please note: Offices may elect to contact you via your home or local address regardless of your preference.
As an example, all Financial aid settlement checks and W-2’s are sent to your HOME address regardless of preference.
• International students must submit all demographic changes to the Office of International Studies and Programs.
P LOCAL ADDRESS (where you will reside while attending school)
Complete this section only if the address is different than the address listed above.
Check if applicable:
n
This LOCAL ADDRESS is my preferred mailing address.
n
I am a GRADUATION APPLICANT and I would like my diploma sent to this address.
Street / P.O. Box ________________________________________________________________________________________________
City _____________________________________________________ State _________________ Zip code ______________________
Telephones: Home ( ____________ ) ___________________________ Cell ( ____________ ) ________________________________
