• If you wish to pay for your course(s) with a bank card or credit card (Visa, Mastercard, or Discover), you may submit this form electronically over the Web through this secured connection.



• If you wish to pay for your course(s) with a check or money order, complete this form, print it out, and then send it with payment (in U.S. dollars) to the following address: BYU Independent Study; 206 Harman Building; Box 21514; Provo, UT 84602; USA.



• If you are paying by check and wish to purchase textbooks from the BYU Bookstore, please include a separate check made payable to the BYU Bookstore for the cost (in U.S. dollars) of the textbooks plus Shipping and Handling. Click here for the Shipping and Handling chart. If you wish, you can review our FERPA policy.



• If you are a student living outside of the US, an extra mailing fee will be charged on your credit card of $15.00 for Canada and Mexico and $20.00 for everywhere else. This fee pays for DHL express shipping of a manual or materials (not textbooks) and any other letters we send during your enrollment of the course. For details, please email us at indstudy@byu.edu or call us at 801-378-2868.



• To have your materials expressed, please do not use this form to register. Instead, call 1-800-914-8931 to register and request expressed shipping.



• If you will be using Independent Study credit to satisfy high school or university graduation requirements, please view our graduation deadlines.



• If you have a disability and are considering enrollment, you are invited to discuss both the program requirements and available assistance prior to registration.

Social Security Number - -	Birthdate (mm/dd/yyyy) / /	Gender male female
Last Name	First Name	Middle Name
Mailing Address (please include Apartment number if applicable)
City	U.S. State	U.S. Zip Code
Country (Required if not U.S.)	Foreign Postal Code
Phone Number -	Fax Number -
Email Address (Required for web course enrollment)		An ACT code is only required for high school students. You can get this number from your high school's counseling office or click here to find it online.. By supplying an ACT code, you give BYU Independent Study permission to inform your High School with your activity and grades in the course[s].
High school or university you are attending (if any)		High School ACT Code

If you're using a printed version of the catalog, check our online catalog first for accurate information, especially for the 7-digit registration code. The online catalog is updated on a daily basis and contains the most current and correct information, which is not reflected in the print catalog.

Registration Code 7-digit number (refer to catalog)	BYU Bookstore Textbooks Order Select the textbooks you wish to order from the BYU Bookstore. You can select "all" if you wish to receive all required texts for a course. If you wish to purchase your texts elsewhere, select "No" for all. For your convenience, links to various online bookstores have been provided in the online course catalog.  Please note: If used books are available, you will receive the used copy at a discounted price. New books will be provided if used are not available.
Course 1	all 1 2 3 4 5 6 7 8 9 10 11 12 13 Yes No
Course 2	all 1 2 3 4 5 6 7 8 9 10 11 12 13 Yes No
Course 3	all 1 2 3 4 5 6 7 8 9 10 11 12 13 Yes No
Card Number (Visa, Mastercard, Discover, or American Express)   Card Expiration Date (mm/yyyy) / Please, only click the Submit Enrollment button once. If you do not receive a response several minutes after submitting your enrollment form, do not click the Submit Enrollment button again, because your credit card could be charged twice. For assistance, please call toll-free 1-800-914-8931 or (801) 378-2868 and press "1" to be connected to Registration. They will check to see if your enrollment has gone through.