Change of Address Form

 

Name:______________________________________

 

ID# or SS#: ________________________

 
Old Address
 

Street: _____________________________________

 

City/State/Zip: _______________________

 
New Address
 

Street: _____________________________________

 

City/State/Zip: _______________________

 

Home Phone #: ____________________

 

Work Phone #: _______________________
 

Please answer the following questions to the best of your knowledge:

Yes No 1. Do you receive Financial Aid?
Yes No 2. Have your parents moved to this address?
Yes No 3. A. Are you an independent student?
Yes No     B. Are you 24 years of age or older?
Yes No 4. A. Are you married?
Yes No     B. Are you residing at this address?
Yes No 5. Is this a temporary local address while enrolled at Gardner-Webb?
Yes No 6. Are you an international student and wish all mail to be received at this address instead of being mailed to your home country?
 
Signature: ___________________________________ Date:___________________
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For Office Use Only
 
Received By: ________________________________ Date: ___________________
 
Record Updated by: __________________________ Date: ___________________

Mail form to: Gardner-Webb University
Registrar's Office
PO Box 997
Boiling Springs, NC 28017
Fax to: 704-406-4261