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Change of Address Form

	(Daytona Beach Campus Students Only)
	* Required Field
	Student Number	*
	ERAU Box Number
	Last Name	*
	First Name	*
	Middle Initial
	E-mail Address	*

	1. Address
	Permanent Address:
	Address
	Address Line 2
	City
	State		Zip
	Country
	Telephone (xxx-xxx-xxxx)

	2. Address
	Local Address:
	Address
	Address Line 2
	City
	State		Zip
	Telephone (xxx-xxx-xxxx)

	Selecting your preferred Address
	Select which address is your Preferred Mailing Address	1 Permanent Address* 2 Local Address*


	Questions, Comments or Additional Information:

I hereby certify that this form constitutes an official submission for processing.
Name:	*	Date:	11/21/2009