CHANGE OF PERMANENT ADDRESS
STUDENT INFORMATION:
Last Name:
First Name:
Student #:
A
Date:
NOTE:
Permanent Address (Required): Can only be changed by filling out this form. We use this address before and after the academic
term starts and during the holiday break in December.
Local Address: Change this address on Self Service Banner. We use the local address during the academic year when we believe you
are in the Halifax area.
Residence Address: Address gets updated by Residence Department. We use this address as the first choice during the academic year.
Residence will inactivate the address at the end of April.
You are required to have a valid permanent address at all times. Failure to do so will result in a registration hold being
placed on your account.
ADDRESS INFORMATION:
Street:
Apt #,
P.O. Box, RR #:
Town/City:
Province:
Postal Code:
Country:
Home Phone:
Mobile Phone:
Signature:
Date:
OFFICE USE ONLY:
Date Received:
Notes:
Date Processed:
Processed By:
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