New Information Report Form

If you have changed your on campus room, or off-campus address, please let us know within 10 days of making this change, and we will notify INS using the SEVIS system. Please note that this address must be where you are actually living, and not just where you receive your mail.

Name: *

Please write your First and Last name.

Effective Date:

Enter date of information change.

Student Information

Class Level: *

Major / Concentration: *

Expected Last Semester: *

Example: Fall 2014

Student ID#: *

Active E-mail:

Ashland University Dorm (Building & Room):

Example: Clayton 222

Campus Mail Box #:

Phone:

Example: 1-419-289-0000

Street Address, if not in dorm.

Street:

City:

State:

Zip Code:

Example: 44805

Comments or Questions:

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