TSU Distance Learning Change of Information Form

Please complete and submit the following form to change any information in the Distance Learning Center files.

Enter the information currently on file with the Distance Learning Center:

Student's First Name:		M.I.:
Student's Last Name:		Suffix:

Social Security Number:
E-mail Address:
	Please use your @troyst.edu e-mail address if known.

Primary Telephone:		Ext:
Secondary Telephone:		Ext:

Address:

Street Address:
Street Address:

City:

State:

Zip:

County:

Country:

Use the following section to enter ONLY the information that needs to be changed.

Student's First Name:		M.I.:
Student's Last Name:		Suffix:

E-mail Address:
	Please use your @troyst.edu e-mail address if known.