OFFICE OF THE UNIVERSITY REGISTRAR
Mailing Address: P.O. Box 1796 • Edmonton, Alberta, Canada T5J 2P2
Phone: 780-497-5000 • Toll Free: 1-888-497-4622
Website: www.MacEwan.ca • E-mail: info@macewan.ca
FREEDOM OF INFORMATION & PROTECTION OF PRIVACY
Protection of Privacy - The personal information requested on this form is collected and protected under the authority of Part 2 of the Alberta Freedom of Information and Protection of
Privacy Act and the Post-Secondary Learning Act. It will be used for the enrollment process and student management consistent with that purpose. This information will be entered into and
retained in the official university student information system database. Direct questions expressly related to the collection and use of this information to the Associate Registrar, Records,
Office of the University Registrar, MacEwan University, 10700-104 Avenue, Edmonton, AB, T5J 4S2, telephone 780-633-3110.
CHANGE OF PERSONAL INFORMATION
PLEASE COMPLETE THE APPLICABLE SECTION(S) BELOW AND SUBMIT TO
THE OFFICE OF THE UNIVERSITY REGISTRAR.
INDIGENOUS ANCESTRY UPDATE
LEGAL NAME
ADDRESS AND PHONE NUMBER
STUDENT ID #:
FAMILY (LAST) NAME: FIRST NAME:
FAMILY (LAST) NAME: FIRST NAME: MIDDLE NAME(S):
A STUDENT WISHING TO HAVE THE UNIVERSITY RECORDS REFLECT A LEGAL NAME CHANGE MUST PROVIDE THE OFFICE OF THE UNIVERSITY REGISTRAR WITH AT LEAST ONE OF
THE FOLLOWING VALID GOVERNMENT ISSUED IDENTIFICATIONS:
• DRIVER’S LICENSE • PROVINCIAL ID CARD • PASSPORT • PERMANENT RESIDENT CARD
ADDRESS: CELL PHONE:
CITY: PROVINCE: HOME PHONE:
POSTAL CODE: COUNTRY: OTHER PHONE:
PERSONAL INFORMATION COLLECTION NOTICE
The personal information requested on this form is collected under Section.33(c) of the Freedom of Information and Protection of Privacy Act for the purpose of one
or all of the following: to determine eligibility for admission and financial assistance, to advise students about academic programs and to provide university services
at MacEwan University. Questions concerning this collection should be directed to the Lead, Privacy and Information Management at privacy@macewan.ca
GENDER IDENTITY UPDATE
MALE FEMALE GENDER MINORITY
I HAVE CHANGED MY LEGAL NAME TO:
I HAVE CHANGED MY ADDRESS/PHONE NUMBER TO:
FIRST NATIONS – STATUS FIRST NATIONS – NON-STATUS INUIT MÉTIS
I WISH TO DECLARE THAT I AM AN INDIGENOUS PERSON AS SPECIFIED BELOW (CHECK ONE):
STUDENT SIGNATURE: _____________________________________________________________________________ DATE:_____________________________________________________________
UPDATED BY STAFF:_____________________________________________________________________________ DATE ENTERED: _____________________________________________________________
OFFICE OF THE UNIVERSITY REGISTRAR OFFICE USE ONLY
LEGAL NAME ADDRESS/PHONE GENDER IDENTITY INDIGENOUS ANCESTRY
UPDATED APRIL 2018
BY SIGNING, I CERTIFY THAT THE INFORMATION ON THIS FORM IS COMPLETE, CORRECT AND TRUE.
Signature not required if sent from a student @mymacewan.ca email account
