Office of the Registrar

 

Please fill in the information requested below.  If you are uncomfortable submitting this information over an unsecured server, please print this form and fax it to our office at (325) 670-1261.

 


Name: *  Date: *
Previous Names:
* Student ID:  
Marital Status: Single  Married  Separated  Divorced *
Home Address:

  (Parents address required if under 25 years old and unmarried)   Preferred Residence     Preferred Mailing   Grades
Home City: Home State: Home Zip Code:
Home Phone:
Local Address:

  (Student's residence if not living at home or in dorm)   Preferred Residence     Preferred Mailing  Grades
Local City: Local State: Local Zip Code:
Local Phone:
Campus Box No.:

Campus Phone:

  Preferred Mailing

Dorm:

  Room # 

Accounts Receivable

Address:

(Monthly statements)

 
A/R City: A/R State: A/R Zip Code:
A/R Phone:

E-Mail Address:

*

 

(Please indicate the e-mail address that you check regularly.)
* Required Fields

 

Please complete every address that is applicable to your situation. 

This will insure that your mail is getting to the proper address.

Preferred Residence:  HSU recommends the Home Address for reporting purposes.

Preferred Mailing:  Address where you would like to receive your mail.
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Administered by Loreta Pugh