Pitzer College Office of the Registrar
Student Contact Information
STUDENT NAME ID NUMBER
New address or phone:
Street
City State
Zip Country
Check appropriate NEW address categories (check all that apply):
Permanent Off-campus local Billing
Parent’s address or Mother’s address Father’s address
Phone Check one: Cell* Home
*This number will also be used to send emergency notifications
Old address or phone to delete:
Street
City State
Zip Country
Phone Check one: Cell Home
Check appropriate categories in which to delete old address (all that apply):
Permanent Off-campus local Billing
Parent’s address or Mother’s address Father’s address
Student Signature: Date ________________________
Office use:
Date Processed _________________________ Initials ____________
s:/Forms/Student Contact Information Change Form
click to sign
signature
click to edit