This form is only for organizations who are moving locations. If you are a proctor changing organizations, please fill out a new proctor application.

Name *

Organization *

Birthdate

We use this to verify we are changing the record of the correct person.

Month

Day

Year

Business Email *

Business Phone *

Please enter your new mailing address *

Street City, State, Zip Country

Physical address for express mail (if different)

Reason for address change *

Proctor Address Change Request

Contact BYU Independent Study