Request a change to your data or password

Please fill out this form to the best of your ability and submit. Psi Beta will update your member information as quickly as possible. We will notify you by email after your changes are complete.

Original Psi Beta member information

(Enter the information we would currently have on record for you, as best you can)
Name I am registered with at Psi Beta*

First
Last
Psi Beta College/Chapter I am a member of
Approximate induction date

MM

DD

YYYY
Email address you would have on file for me
My current email address*

We will email our reply to this email address
Mailing address you would have on file for me

Street Address
City

State
Zip Code
Information I am requesting be changed on my account

(As you check a box (below), an entry form to change that information will display.)
(check at least one box)*
- Name
- Password
- Email
- Address
Change my name to*

First
Last
Change my password to*

Our system requires passwords to be a minimum of 8 characters, and to contain upper and lower case letters and at least one number. Please be sure your requested password meets these criteria. Thank you!
Change my email address to*
Change my address to*

Street Address
City

State
Zip Code

Request a change to your data or password

Original Psi Beta member information

Information I am requesting be changed on my account