SRO/ Forms/ Change of Address Rev: 2014-02-26
Change of Address Form
Address changes can be updated online via myNIC, or mail or fax form to:
Registrar, North Island College (see below for campus addresses)
Student Name: _________________________________________________ Student No: __________________________
NEW ADDRESS: ______________________________________________________________________________________
_____________________________________________________________________________________________________
City: ____________________________________ Province: _________________ Postal Code: _________________
Phone No.
(including area code): __________________________________ Birth Date (yyyy/mm/dd): ___________________
Email: _______________________________________________________________________________________________
Student Signature: ______________________________________ Effective Date: _____________________________
I understand that this information, along with subsequent information, is collected under the authority of the College and Institute Act.
This information will be protected and used in compliance with the BC Freedom of Information and Protection of Privacy Act for the
purpose of admission, registration, research, and other purposes consistent with the mandate of the institution.
Please Mail or Fax this form to the Registrar, North Island College, at one of the locations below:
Mt. Waddington Campus
1685 South Dogwood Street 2300 Ryan Road 3699 Roger Street PO Box 901
Campbell River, BC V9W 8C1
Tel: 250-923-9701 Tel: 250-334-5000 Tel: 250-724-8711 Port Hardy, BC V0N 2P0
Fax: 250-949-2617
FOR OFFICE USE (only):
Date Received: ______________________________________ Received by: ____________________________________________________
(Signature in Full)
Date Entered: ______________________________________ Entered by: ____________________________________________________
(Signature in Full)
