OFFICE OF THE REGISTRAR ASSUMPTION COLLEGE

500 Salisbury Street Worcester, MA 01609-1296

CHANGE OF INFORMATION

STUDENT’S NAME:________________________________________________________________________

(PLEASE PRINT)

ID #: _____________________CLASS OF:___________CAMPUS BOX NO:__________

PLEASE CHANGE MY RECORDS TO REFLECT THE FOLLOWING ADDRESS CHANGES:

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STREET

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CITY STATE ZIP CODE

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AREA CODE PHONE NUMBER

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PLEASE ALSO CHANGE MY PARENTS’ ADDRESS:

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STREET

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CITY STATE ZIP CODE

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AREA CODE PHONE NUMBER

OR MOTHER’S ADDRESS:

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STREET

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CITY STATE ZIP CODE

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AREA CODE PHONE NUMBER

OR FATHER’S ADDRESS:

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STREET

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CITY STATE ZIP CODE

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AREA CODE PHONE NUMBER

PLEASE RETURN THE COMPLETED FORM TO THE REGISTRAR’S OFFICE