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Change of Address

MISSOURI SOUTHERN STATE UNIVERSITY
OFFICE OF THE REGISTRAR



This form can be used by students, student workers, student employees and work study recipients to request a change of address. If you are an employee who is also a student you must submit your address change request through Human Resources. Any requests using this form will not be processed.

Check Each That Apply
Student:
Student worker, student employee, or work study:
Employee:
All employee address change requests must be processed through Human Resources. Any requests using this form will not be processed.
*Last Name: 
*First Name: 
Middle Name: 
*Student ID Number: 
Check if you know your anticipated graduation date:
*Anticipated graduation date: 
*Do you want your mailing address changed for your diploma?
Change mailing address to:
*Street Address or P.O. Box: 
*City: 
*State:
*Zip Code: 

*Phone: 
Secondary E-Mail: 
Update Emergency Contact Information?
*Name: 
*Relationship: 
*Street Address or P.O. Box: 
*City: 
*State:
*Zip Code: 
*Phone: 

THIS FORM WILL BE MADE AVAILABLE IN ALTERNATIVE FORMATS UPON REQUEST. IF YOU NEED ASSISTANCE, PLEASE CONTACT THE REGISTRAR'S OFFICE at (417)625-9515.
The following information will constitute as an electronic signature.
*Student E-Signature: 
*Today's Date: 
SID
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