Juniata College - Office of the Registrar: Address Change Form

Office of the Registrar

Address Change Form

General Information

Student ID#:

Name:

Effective Date:

Campus Box:

Campus Ext.:

E-Mail:

Old Address

Street Or Rd

Box Or Apt #

City

State

Zip

Telephone Number

New Address

Street Or Rd

Box Or Apt#

City

State

Zip

Telephone Number

Check All That Apply

This is:

Permanent Change

Temporary Change

from

to

Student Address

Parent/Guardian/Spouse Address

Billing Address