Change of Address Form

Fill out the form below to submit a change of address to Iowa Central Distance Learning.

* indicates a required field

* First Name: A value is required.
* Last Name: A value is required.
* Last 4 Digits of SSN: A value is required.
* Prior Address: A value is required.
* Prior City: A value is required.
* Prior State: A value is required.
* Prior Zip: A value is required.
     
* Current Address: A value is required.
* Current City: A value is required.
* Current State: A value is required.
* Current Zip: A value is required.
* Phone Number: A value is required.
     
You must certify the information is correct to continue. I certify that the information above if correct and is my current address of residence. I understand that I must contact the Distance Learning Office immediately to discuss future enrollment options at 515-574-1098.

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