Update Residency on Submitted Application Form NEW

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Jacksonville State University

Office of Admissions

700 Pelham Rd N., 304 Theron Montgomery Bldg., Jacksonville, AL 36265

Phone: (256) 782-5268

http://jsu.edu/admissions

admissions@jsu.edu

Update Residency on Submitted Application

Contact Information

First Name:

Last Name:

Email:

JSU ID#:

Date of Birth:

Phone Number:

Enter Permanent Address Information

Street Address:

City:

State:

Zip:

Do you currently reside (live) in the state of Alabama or the following ten Georgia Counties (Bartow, Carroll, Chattooga, Coweta, Douglas, Floyd, Haralson, Heard, Paulding, Polk)?

By answering yes, you certify that your address listed is correct and that it is your present intent is to remain at that address indefinitely and maintain substantial connections within the state of Alabama.

By answering no, you are certifying that you are an out-of-state-student.

By entering my name below, I confirm that the information provided on this form is complete and accurate to the best of my knowledge.

First Name:

Last Name:

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