OFFICE OF THE UNIVERSITY REGISTRAR
P.O. Box 1796 • Edmonton, Alberta, Canada T5J 2P2
Phone: 780-497-5000 • Toll Free: 1-888-497-4622
www.MacEwan.ca • recordsunit@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 ocial university student information system database. Direct questions expressly related to the collection and use of this information to the Associate Registrar, Records,
Oce of the University Registrar, MacEwan University, 10700-104 Avenue, Edmonton, AB, T5J 4S2, telephone 780-633-3110.
PARCHMENT REPLACEMENT FORM
PART 1
TO BE COMPLETED BY THE STUDENT
STUDENT ID NO.:
FAMILY (LAST) NAME: FIRST NAME: MIDDLE NAME:
FORMER NAME(S) (IF APPLICABLE) ADDRESS: CITY/PROVINCE: POSTAL CODE:
BIRTH DATE:
MM __________ DD __________ YY___________
CHECK IF YOU WISH US TO UPDATE YOUR ADDRESS
HOME PH.: CELL: WORK PH.: EXT.
GRADUATE FROM MACEWAN: YES NO GRADUATED FROM ALBERTA COLLEGE: YES NO
PROGRAM NAME GRADUATED FROM: OLD ALBERTA COLLEGE ID#:
YEAR(S) ATTENDED: PROGRAM NAME GRADUATED FROM:
YEAR GRADUATED: YEAR(S) ATTENDED:
YEAR GRADUATED:
MAY TAKE 4 - 6 WEEKS TO PROCESS
IF THERE IS A CHANGE IN YOUR FAMILY (LAST) NAME, PLEASE SUBMIT A NAME CHANGE FORM WITH THE APPROPRIATE OFFICIAL DOCUMENTATION.
Note: If this is a name change, the student must provide the Oce of the University Registrar with one of the following ocial Government Issue identication.
Valid Drivers license* Provincial ID Card* Valid Passport* Citizen Documentation*
*Only current ID will be recognized as valid. Expired ID will not be accepted for a name change.
The Oce of the University Registrar’s oce sta member shall verify ID and record the applicable number on the form.
MAILING/ PICK UP INSTRUCTIONS
WILL PICK UP AT: (Photo Identication is required at the time of pickup)
CITY CENTRE CAMPUS (CCC) ALBERTA COLLEGE CAMPUS (ACC)
OR
MAIL TO MY HOME ADDRESS (As listed above)
STUDENT SIGNATURE: _______________________________________________________________________ DATE: _________________________________________
I AM AWARE THAT MY CREDENTIAL WILL NOT BE RELEASED IF I HAVE NOT CLEARED ANY OUTSTANDING OBLIGATION OWED BY ME TO MACEWAN UNIVERSITY FOR FEES, SUPPLIES, EQUIPMENT, OR RENTALS.
OFFICE USE ONLY
ENTERED BY: _____________________________________________________________________________ DATE: ____________________________________________________________________________________
SENT BY: ________________________________________________________________________________ DATE SENT: _______________________________________________________________________________
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 nancial 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
Signature not required if sent from a student @mymacewan.ca email account
