Change of Address Form

Complete this address change form online. This page is best viewed with Internet Explorer 4.0,  Netscape 5.0 or better.  TO UPDATE EDUCATION LEVEL and/or  to obtain a hard copy for completion please click on Human Resources Forms and print.  To update personal data with MOSERS, click on Notification of Change Form and print.

Name: 

Dept:      
Social Security No.:
Effective Date:

Section I: Change or Correction of Name:

From: 
To:
Reason:

Section II: Change of Address,

Street Name: 
City: 
State:
Zip:
Phone: 
Cell Phone:

 Section III: Change in Emergency Contact Information

Name:
Relationship:
Phone:

 Section IV:

Mailstop: 
Extension: 
Campus Address:

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©Southeast Missouri State University
Last Updated February 12, 2002