Change of Current Mailing Address / Email Address

Student Name:
Last (Family)
First
Middle

Oregon State Unviversity ID Number (9 digits):
(If you do not have an OSU ID Number yet, leave above box empty.)

Email:

Date of Birth: Month Choose month January February March April May June July August September October November December   Day Choose day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   Year

Phone Number:

(By clicking the Submit button, I certify that all information on this form has been completed to the best of my knowledge and this action will represent my signature.)