Change of Address Form

PLEASE NOTE: You will need to notify the University separately of your address change. You can do so on-line by logging into Bear Facts and following the links there. Information on privacy of student records can be found HERE.

We do not have direct access to Bear Facts, so please use the form below to notify us of your address change. First Name, Last Name and Primary Email are required*. Otherwise you can complete the form, or just fill in the information that has changed.

Please use the tab key or mouse pointer to proceed to the next field; hitting the return key may submit the form prematurely.

Name:

Prefix: *First Name:

Middle Name:

*Last Name: Suffix:

Nickname (i.e. Jim, Peg):

Home Info:

Home Address:

City: State: Zip:

Home Phone:

Cell Phone:

*Primary Email:

Note: AOL and Comcast block the CalMail listserv, so please do not submit either of those as your primary email address. Current students are required to use CalMail.

Alternate Email:

Contact Preferences (i.e. cell phone, email, etc.):

Work Info:

Title:

School/Organization:

School Type:
Hold Ctrl (Windows) or Command (Mac)
while clicking to select multiple types

District:

Work Address:

City: State: Zip:

Work Phone: Ext.:

Work Fax:

Principal/Site Supervisor:

Notes:

Clicking "Submit" will email your information to pli@berkeley.edu
Clicking "Reset" will clear all of the form fields

Your information will only be used for the Principal Leadership Institute's internal database