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 ( ____________ ) ________________________________