College of Engineering >> Distance Learning >> Graduate Outreach Program >> Protected forms

Change Address Form

If we have to make dubs and resend material because you didn't inform us of your move in time to either hold or correctly address your shipment, you may be billed for the extra dubbing and shipping. Copies of DVD-R are $10 and Express shipping is $6. 

   

Identification (Required!)
This information will be used to assure the correct student's information is changed. Please input the information that is currently being used by the GOP. 
Your Name:   
Your Email:

Current Classes (Required!) (example: INSY 7006)
Class 1:
Class 2:
Class 3:

Proctor Address Change 
Will You Be Changing Proctors? Yes No
If Yes... 
New Proctor's Name:           
New Proctor's Email:            
New Proctor's Phone Number:

Proctor's Address 1
Proctor's Address 2
City		State	Zip

Delivery Address Change

 

	Effective Date
Name
Delivery Address 1
Delivery Address 2
City		State	Zip

Phone Number Change

 

New phone numbers:		Effective Date
Home
Office
Cell

E-mail Change

Old e-mail address
New e-mail address