5500 WABASH AVENUE TERRE HAUTE, IN 47803-3920 PHONE: 812-877-8285 FAX: 812-877-8746 www.rose-hulman.edu
OFFICE OF STUDENT AFFAIRS – INTERNATIONAL STUDENT SERVICES
CHANGE OF ADDRESS FORM
The US Federal Government requires that all international students have updated information
in the Student and Exchange Visitor Information System [SEVIS]. An accurate physical address
is required, especially for those living off-campus.
This form must be returned to the PDSO –Principal Designated School Official – within 10 days
of the start of classes to notify us of your current address.
This form is only for those who live off-campus.
Name_________________________________________________________________________
Street name & building #__________________________________________________________
Apartment complex name [if applicable] _____________________________________________
Apartment # [if applicable] _______________________________________________________
City _________________________________State___________________Zip code____________
Return to:
Karen DeGrange, PDSO, ARO
Director, International Student Services
Rose-Hulman Institute of Technology CM # 39
Terre Haute, IN 47803
Fax 812-877-8746
degrange@rose-hulman.edu