Office of the Registrar : Forms

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Change of Address Form

Change of Address Form

First Name:

MI

Last Name:

Student ID:

University Email Address:

Telephone:

Are you a student worker at Western?

YesNo

Old Address:

Address:

Zip:

City/Town:

State

New Address:

Address:

Zip:

City/Town:

State

By selecting the "I Accept" button, you are are agreeing to sign this form electronically and that your typed signature is the legal equivalent of your manual signature. Falsifying a student's signature is a violation of FERPA regulations.

I Accept

Student signature (typed):

Contact Information