Change of Address/Telephone/Marital Status

Name ____________________________ Ten Digit University ID ____________________________
Please change the following information: (check one)
____________Local Only ____________Student Home Only ____________ Local and Student Home
Old Street ___________________________ New Street ___________________________
Old City ___________________________ New City ___________________________
Old State ___________________________ New State ___________________________
Old Zip ___________________________ New Zip ___________________________
Old Phone ___________________________ New Phone ___________________________
Old County ___________________________ New County ___________________________
Please note that all official university mail for students on the IUPUI campus is sent to the student's local address*
Change Marital Status to:  (check one)  _______ Single  _______ Married    (used for summary reporting only)
Change Parent Information:
Name ________________________________________________________________________
Street ________________________________________________________________________
City ________________________________________________________________________
State ________________________________________________________________________
Zip ________________________________________________________________________
How can we reach you if we have questions:
E-mail ______________-_________________  Daytime Phone ________________________________ 
Student Signature  ____________________________________________________________________
*We remind you that for most IUPUI students this address is the same. The student home address is the address displayed on the official transcript.
Fax to: 317-278-2240

Mail to/Visit us at :
Office of the Registrar
Campus Center, Suite 250
420 University Boulevard
Indianapolis, Indiana 46202-5144

Copyright - The Trustees of Indiana University