Personal Information Update Form

Name and Address Change Form

Student Name:
Student ID Number:
Effective Date:
Please complete the following fields that apply to you.
Previous Address
Address:
City:
State:
Zip Code:
Phone Number:
New Address
Address:
City:
State:
Zip Code:
Phone Number:
Cell Phone Number:
Please check one of the boxes below:
Local: Permanent: Summer:

If you are changing your name as well as your address, please print the following document and follow the instructions for updating your information.
- View PIU Form in Adobe PDF
- Download PIU Form in MS Word

For more information, please call at
1-888-378-9988 or email to

addrweb@dsu.edu