Change Form - Address/Phone/Household/Email

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	This form should be used to notify Cloquet Schools of any changes to your address, phone number or family members.

1.	Requested By (Your First and Last Name)

2.	Student Name(s) (First, MI, Last)

3.	Current Grade(s)

4.	Reason For Address Change
	Reason For Address Change Student AND family moved to NEW address. Student AND family moved to TEMPORARY address. Parent moved, student living elsewhere. Add/Change Secondary HH address. Student living with someone other than parent/guardian. Remove an address. Add as Mailing address, make other address Secondary. If Other, Please Describe

5.	Current/New Address (Complete if Address Change)

6.	List all members and their relationship to the STUDENT that will reside at the new address. (Complete if address change or if household members changed.)

7.	Effective Date of Address Change (mm/dd/yyyy)

8.	Old Address OR Now Secondary Address

9.	Home/Cell/Work Phone (Complete if Adding or Changing)

10.	Email Address (Complete if Adding or Changing)

11.	Emergency Contact Change (Please list first and last name of contact along with contact numbers. Use a comma between each contact.)

	Please contact Cloquet Transit at 218-879-1291 for new busing information if this is an address change. Thank you!

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