Change of Address,Telephone,& Name Form

UW-Madison Exchange Visitor
Change of Address, Name, and/or Telephone Form

*For use by international J-1 exchange visitors only*

This form is to be used by all UW-Madison J-1 Scholars to report change of name, address, or telephone number to IFSS within 10 days of such change. Failure to report within 10 days can result in problems with your J-1 program.

Please Type or Print
No P.O. Boxes Accepted for Addresses

Old Information
Last Name First Name Middle Name
Current address (City,State) (ZIP Code)
Date of Birth: (mm/dd/yy) Country of Citizenship
Phone # Sponsoring UW-Madison Department
New Name, Address, or Phone
Last Name First Name Middle Name
New Address (City,State) (ZIP Code)
Phone #

Questions, comment, or accessibility issues to ohrwebmaster@ohr.wisc.edu
Last updated January 21, 2005