410 Union Building
Office USE ONLY
200 S. Central Campus Dr.
Staff initial: ___
Salt Lake City, UT 84112
# credits: ___
Tel: (801) 581‐8876
Fax: (801) 581‐6388
E‐mail: international@utah.edu
ADDRESS UPDATE FORM
Immigration regulations require all international students report any address change to
International Student & Scholar Services within TEN days. This form will update your
address for the SEVIS Immigration Database and University of Utah’s Campus
Information System. Please allow up to 5 days for the change to appear in the Campus
Information System.
Last Name: __________________________ First Name: ___________________ Date: _____________
Student ID#: ____________________________
Circle one: Male/Female Visa Type: F-1/J-1
E-mail Address: _________________________
Local Phone: ___________________________
Major/Field of Study:______________________
Circle your degree level: Bachelors/ Masters/ PhD
Birth Date: __________________ (mm/dd/yyyy)
Is this your first semester at the U: □ YES □ NO
PLEASE PRINT CLEARLY!
NOTE: If you are currently working on campus, you should also update your home address with Human Resources. We
will update your SEVIS & mailing addresses. If you are on any other type of visa than the F visa or the J visa, you will
need to file an AR-11 form with Immigration. The form is available at
Address Update Section
Street Address: ________________________________________________________
______________________________________________________________________
City: _____________________________ State: _____ Zip Code: ____________
Heritage Center Box #__________
(For on-campus housing only)
□
□
Phone Number:(_____) ___________________
Cell Phone
Main Phone
Campus Email Address:______________________________________________
Non-campus Email*: _________________________________________________
A campus email address is connected with the University. An example is u050xxxx@utah.edu or jlastname@chem.utah.edu.
*A non-campus email is a gmail, hotmail, yahoo, naver or a similar address.
Signature:________________________________
Today’s Date:__________________
Last updated 6/12/14 nn