Change of Address

Full Legal Name: Old E-mail address: New E-mail address: Old Address: Street & Apartment: City: State: Zip Code: Country: New Address: Street & Apartment: City: State: Zip Code: Country: Old Telephone: New Telephone: Today's Date: / / (MM/DD/YY) Effective Date of Change: / (MM/YY) Last Semester Enrolled at CSU-Pueblo: / (MM/YY) Additional Comments: I hereby certify to the best of my knowledge that the information furnished is true and complete. By checking this box you have created an electronic signature as legally binding as your hand-written signature. Student Signature