For Medical Students
 

If you are a student in the College of Medicine (or past graduate), you can use this form to submit a change of address to the office of Student and Academic Affairs.   You cannot use this form to change your name - that must be done in person in the Student Affairs office.  You can submit this information three ways:

  1. Print out the form, fill it out by hand, and return it to: College of Medicine; Office of Student and Academic Affairs; 4301 W. Markham St., #603; Little Rock, AR  72205 OR FAX it to 501-686-8160;
  2. Type the information into the form, print it and return as above;
  3. Type the information into the form and submit it to us electronically by hitting the "Submit" button.  If you submit this form electronically, a copy will automatically be sent to the Records office and the Financial Aid office, as well as the main office of Student and Academic Affairs.

Please change my address, phone number, or e-mail address in your official records to the following:

Last Name:    *
First Name:    *
Address 1:    
Address 2:    
City:             
State:            
Zip:              
Home Phone:  
Pager or Cell Phone:           
E-mail:           (will not change your e-mail address in the listservs)
Year of Graduation (if past graduate):

Signature:  *
(Use the last four digits of your UAMS ID# or SS# as your signature if you are submitting electronically)

(*) indicates a required field



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