Image/Title: Student Services
form for returning students to report changes
Complete this form ONLY if changes in your plans or personal records occurred over the summer.
Student:            Current Phone #:
Last 4 digits of SS#:            School:            Class Year:
E-Mail address(es):
CHECK ALL THAT APPLY AND UPDATE WHERE APPLICABLE:

Resident to Commuter (Reason: )
Commuter to Resident (Complete online housing application or call 914-654-5862)
School of Arts & Sciences to School of Nursing
School of Nursing to School of Arts & Sciences
Other

New Name:   (Maiden/Former Name):
New Permanent Address:
New Mailing Address:
New Phone:
Other:

I will NOT be returning to CNR this fall because I will be:

Transferring
Withdrawing
On Leave of Absence
On a Visiting Student Program — Describe:
Other: