Address Change and Information Form

Personal Information

Name: *Student ID#:

Birth Date (mm/dd/yy): Sex (M or F):

Ethnicity (optional):



Local Address (where you will be living while attending AiS)

Street: Apt #:

City: State:

Zipcode: Phone #:

Email: Adt'l Phone #:



Billing Address (ONLY if different from local address)

Name:

Street: Apt #:

City: State:

Country: Zipcode: Phone #:



Alternate Address

Street: Apt #:

City: State:

Country: Zipcode: Phone #:



Emergency Contact

Name: Phone #:


*For your own protection, social security numbers cannot be used for the online form.