Change of Address Form for Individuals Not Currently Enrolled
Records Office - Middle Tennessee State University - Murfreesboro

Birth Year
Date

Last Name
First Name
Middle Name

Permanent Mailing Address
(Permanent address for international students must be country of origin, excluding permanent residents)
No. and Street Apt #
City State Zip
County Phone (ac)

Local Mailing Address
No. and Street Apt #
City State Zip
County Phone (ac)

Spouse/Parent/Guardian/Next of Kin:
Last First Middle
Relationship
No. and Street Apt #
City State Zip
County Phone (ac)

Mailing Address for Grade Reports (if different from permanent address)
No. and Street Apt #
City State Zip

E-Mail address (Other than MTSU-assigned address.)