• Student ID Number(WIN)*
• Wilkes University Email Address*
• First Name*
• Middle Name
• Current Last Name*
• Address type you would like to change*
  Home/Permanent Local
• Effective Date of Address Change* MM/DD/YYYY
• Old Address Information (to be inactivated)*
  Street Address
  Address Line 2
  City
  State / Province / Region
  Postal / Zip Code
• Telephone (Old)* - (###) - ### ####
• Cell Phone (Old) - (###) - ### ####
• New Address Information*
  Street Address
  Address Line 2
  City
  State / Province / Region
  Postal / Zip Code
• Telephone (New)* - (###) - ### ####
• Cell Phone (New) - (###) - ### ####
• Comments
• Leave this field blank

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