College of Veterinary Medicine

From time to time students may move or marry during their tenure at the college of veterinary medicine. To address the changes, please complete the requested information on this form and submit it. This will allow the college administration to update your records in the college information systems.

In addition to completing this form, you will need to update your address through Buckeye Link as well as submit a Request for Change of Record form to ensure the Registrar's office is also notified of your changes.

Current Personal Information

First Name: *

Last Name: *

Name.# Email Address: *

Class Year: * - Select -VME IVME IIVME IIIVME IV

Name Change Information

New First Name:

New Middle Name:

New Last Name:

Address Change Information

Street Address (New):

Apartment/Unit (If applicable):

City:

State: - None -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming

Zip Code:

Telephone Number (Current/New): (xxx) xxx-xxxx

Emergency Contact Information Change (If applicable)

First Name:

Last Name:

Street Address:

City:

State: - None -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming

Zip Code:

Telephone Number: (xxx) xxx-xxxx

Please Note: This information will be submitted to the appropriate department within the college and will not be shared with employees who do not have a need to have this information.

**It is the student's responsibility to notify the college and the university of changes in contact information.**

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