Address Reporting Form
for F-1 International Students
General Information: F-1 international students are required by U.S. law report their address to the Department of
Homeland Security (DHS). When an F-1 student changing his/her address, the student must report the change to his/her
Foreign Student Advisor within 10 business days. This form will be used to update the student’s SEVIS record with DHS.
*** All F-1 International Students are required to notify their Foreign Student Advisor within 10 days of
a change of address or phone number. ***
Student Name: _______________________________________ Liberty ID #:___________
(If you live off campus, please provide your complete address.)
Street/PO box:
Apartment:
City:
State:
Zip Code:
Phone #:
Parent/Guardian name:
Street/PO box:
Apartment:
City:
State/Province:
Country:
Zip Code:
Phone #:
Email:
Emergency Contact: This is the person we would call if you became ill or injured.
Name:
Relationship:
Phone #:
E-mail:
Student Signature: ________________________________________ Date: __________________
Office of International Student ServicesLiberty University, 1971 University Blvd., Lynchburg, VA 24515
Phone (434) 592-4118Fax (434) 582-2969mystatus@liberty.edu www.liberty.edu/international
Updated 6/26/12