Change Your Address With Bsu - Bridgewater State University printable pdf download

BSU A

DDRESS AND

ELEPHONE

UMBER

HANGE

ORM

(PLEASE PRINT)

RETURN FORM TO: Human Resources Department (Employees) OR Registrar’s Office (Students)

[See Reverse Side for details]

(If you are both an employee and a student, only one form must be completed and returned to the Human Resources Department.)

Employee/Student Employee

Student

Please check:

Name:

Last

First

Middle

Banner ID:

Last 4 digits of SSN: ___ ___ ___ ___

(8-digit number starting with 0)

Date of Birth:

(for identification purposes only)

Month (mm)

Day (dd)

Year (yyyy)

I certify that I am the above-named person and that all information on this form is correct as stated.

SIGNATURE:

Day Phone Number:

Date:

DDRESS

HANGE

Please check all address types that apply to each address change listed (see reverse side for definitions):

Check all that apply:

Street Address 1

Permanent

Billing

Street Address 2

Local

Mailing

Street Address 3

Parent

City

State

Zip Code

Country (other than United States)

Check all that apply:

Street Address 1

Permanent

Billing

Street Address 2

Local

Mailing

Street Address 3

Parent

City

State

Zip Code

Country (other than United States)

REMINDER TO ALL PERMANENT RESIDENTS, INTERNATIONAL/EXCHANGE STUDENTS AND OTHER FOREIGN NATIONALS:

United States immigration law currently requires that permanent residents, international/exchange students, and other foreign nationals report all address

changes to the Immigration and Naturalization Service using form AR-11 within 10 days of moving. The latest version of the AR-11 form can be downloaded

from the INS website at:

Important Note for Students:

A change of permanent address from out-of state to in-state does not automatically change a student’s residency for billing purposes. A

formal application for in-state tuition is required as outlined on:

ELEPHONE

UMBER

HANGE

Please check only one telephone type for each number change listed (see reverse side for definitions):

Permanent

Cell

Day

Area Code