Fillable Virginia Military Institute (Virginia Military Institute)

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Virginia Military Institute (Virginia Military Institute)

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Country of origin: US
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Virginia Military Institute
Change of Address / Name / Social Security Number
Cadet Name:________________________________________ ID _________________________
Major:_________________________ Class Year:__________ VMI Box #____________________
Directions: Please update on the appropriate line only those items that are being changed – Must be completed by cadet!!
HOME / PREFERRED: ________________________________________________________
ADDRESS: ________________________________________________________
New Phone Number: Area Code:_____ Phone #____________
Effective Date of Change:
Has your State of Residency Changed? Yes No
PARENT 1 ADDRESS: Name:___________________________________________________
Address:_________________________________________________
City, State, Zip: ___________________________________________
Phone Number: Area Code:_____ Phone #________________
Effective Date of Change:
Legal State of Residency/Domicile:_____________________________
PARENT 2 ADDRESS: Name:___________________________________________________
Address:_________________________________________________
City, State, Zip: ___________________________________________
Phone Number: Area Code:_______ Phone:___________________
EMERGENCY CONTACT: Name:___________________________________________________
Address:_________________________________________________
City, State, Zip: ___________________________________________
Phone Number: Area Code:_______ Phone:___________________
FORWARDING ADDRESS: ________________________________________________________
(For temporary use only) ________________________________________________________
________________________________________________________
From:_______________________ To:______________________
NAME CHANGE / SOCIAL SECURITY NUMBER UPDATE: (Identification Required)
Current Name or SSN:_______________________________ Change To:__________________________
I certify the above information to be correct, and that my legal State of Residence has not changed unless otherwise noted above.
Cadet Signature:_____________________________________________ Date:_______________________
Updated 02/13
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Virginia Military Institute (Virginia Military Institute)

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Completed 1 September 2020

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