Change Of Address For Student
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1
2The University of Southern Mississippi
Department of Student Services
730 East Beach Blvd.
Long Beach, MS 39560
Phone: (228) 865-4565 Fax: (228) 214-5461
CHANGE OF ADDRESS FOR STUDENTS
Please Print:
SSN/Student ID:
Date:
Name:
Last
First
Middle/Maiden
Are you currently Enrolled?
Are you an Alumnus/Alumna?
Yes/No
Yes/No
Are you an Employee?
Yes/No
Please make the changes requested below
:
Home address changed to:
Street Address
City
State
Zip
County
Mailing address changed to:
Street Address
City
State
Zip
County
Telephone changed to:
Home Telephone
(
)
Work Telephone
(
)
Cell Telephone
(
)
Email changed to:
Email
Student Signature:
Date
8/2011
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Parent category: Legal