Change Of Address/name Form - Shenandoah University printable pdf download

Change Of Address/name Form - Shenandoah University

Change of Address/Name Form

Hornet Central

Phone: 540-665-4514

Shenandoah University

Fax: 540-665-5433

1460 University Drive

Email:

hornetcentral@su.edu

Winchester, VA 22601

If Faculty/Staff, have you taken any courses at Shenandoah University?

Yes

OLD INFORMATION

Name (F,M,L)__________________________________________ Phone:(

)_________________________

Address:__________________________________________________________________________________

City:____________________________ State:________ Zip Code:_______________ County:______________

NEW INFORMATION

Name (F,M,L)__________________________________________ Phone:(

)_________________________

Address:__________________________________________________________________________________

City:____________________________ State:________ Zip Code:_______________ County:________________

Please Check ALL that Apply:

Permanent Address Change

Other Names Used: _______________________

Local Address Change

Change in Marital Status to: S M D

Billing Address Change (INV)

Preferred Mailing Address?

YES

Preferred Residence?

YES

This change cannot be processed unless the following information is complete. For name change requests, please

include a copy of your updated driver’s license, marriage license/certificate or divorce decree. If you are

changing your permanent address from an out-of-state address to a Virginia address, you must provide

documentation verifying legal in-state residence, such as a copy of your valid Virginia driver’s license.

Thank You.

Signature:__________________________________________________________Date:______________________

ID#:_______________________________________________

Hornet Central Use ONLY

Information entered and verified

By (Initials): ____________________

Date: _________________________

Updated 07/02/14 - NSG

Change Of Address/name Form - Shenandoah University