Florida Gulfcoast University Address And/or Name Change

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ADDRESS AND/OR NAME CHANGE*
Last Name
First
M.I.
University Identification Number (UIN)
PLEASE CHANGE MY ADDRESS(ES)
- COMPLETE IF APPLICABLE, SIGN BELOW
Permanent mailing address cannot be updated to a campus housing address
NEW MAILING ADDRESS:
Street
Check if graduating this term
City
State
Zip code
*Diploma Address
(
)
(If different from mailing address)
Telephone Number
NEW EMERGENCY CONTACT:
Name of Person to Contact in Case of Emergency -
Relationship
Same as above
Street
City
State
Zip Code
(
)
Telephone Number
PLEASE CHANGE MY NAME AS FOLLOWS:
COMPLETE IF APPLICABLE, SIGN BELOW
FROM:
Last
First
Middle Initial
Legal Name
TO:
Last
First
Middle Initial
Legal Name
Reason for Change (check appropriate box(es):
Marriage –
Legal Name Change -
(attach copy of marriage documentation/driver
(Attach copy of court order/ driver
license/social security card)
license/social security card)
– (Attach copy of divorce decree/ driver license/social security card)
Divorce
Other, Explain___________________________________
NOTE: The documents indicated above must be attached to process request.
Student’s Signature is required to process this request(s)
Student’s Signature
Date
*
Note: If you are employed by FGCU, Please make sure to contact Human Resources with Address/Name Changes
Form may be mailed or faxed with valid photo ID
to:
Office of the Registrar
For Official Use Only:
10501 FGCU Blvd. S.
Fort Myers, FL. 33965-6565
Entered into Banner - Initial and Date
(239) 590-7980/Toll Free (888) 373-2040/Fax (239) 590-7983
ORR/04/2005
Rev. 03/2008

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