Student Accounts – Loan Servicing 110 Business Services Building

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Student Accounts – Loan Servicing
110 Business Services Building
Athens, Georgia 30602-4226
Print Form
Phone: (706) 542-6834
Fax: (706) 542-3959
Email: [email protected]
PERSONAL INFORMATION CHANGE AND-OR UPDATE
PREVIOUS INFORMATION:
Full Name: ______________________________________________________________________________
Last four #’s of SSN: ____________________
Previous Address: ________________________________________________________________________
________________________________________________________________________
Previous Home Telephone Number: ______________________
Previous Cell Phone Number: ___________________________
Previous Email Address: ___________________________________________________________________
CURRENT INFORMATION:
Full Name: _______________________________________________________________________
*****If name is changing, please attach a copy of the official document verifying the change.
Current Address: _________________________________________________________________________
_________________________________________________________________________
Current Home Telephone Number: _____________________________
Current Cell Phone Number: __________________________________
Current Email Address: ____________________________________________________________________
*I give permission to the University of Georgia to speak to the following persons pertaining to my UGA loans:
Name: _____________________________________________ Relationship: ________________________
Name: _____________________________________________ Relationship: ________________________
Name: _____________________________________________ Relationship: ________________________
Signature: _____________________________________________ Date: ____________________
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