Change of address form

This information is needed to positively identify you:

Last name: First name:
Middle Name: Maiden/Other:

Date of Birth:

Last Attended GC:

Social Security Number/Student ID Number: - -

E-mail address:


You MUST select ONE address to which this change applies:

1. Mailing: The primary address used for mailings from the Goshen College.
2. Local: Use this address, in addition to your mailing address, if your mailing address is a PO Box or not your local residence address.

3. Temporary: Date sensitive address used to over-ride your mailing address when you are away – between semesters, over the summer, or while on SST. Effective dates from :
to:

4. Parent: Used to send press releases which mention you. Submit an address for EACH parent if they do not live together.

Enter New Address

Name:
Number and Street:
City:
 State:
Zip:
 Telephone:( ) -


Please allow 2 - 3 working days for changes to take effect.
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Goshen College 1700 South Main Street, Goshen, Indiana 46526
Toll free: 1 (800) 348-7422 • Local: (574) 535-7000 • E-mail: info@goshen.edu

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