August 2020
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Alberta Student Personal Information Change
(PIC) Request
This form is intended for students who are no longer enrolled in Alberta’s Kindergarten to Grade 12 (K-12) school system or for
students who do not have internet access but need to update their Name, Birthdate, Gender, Address, Phone, or Email
information.
If you are not enrolled in an Alberta K-12 school, but have internet access and an active myPass account, visit the myPass self-
service website to update your Address, Phone, or Email information online. You must use this form if you need to update your
Name, Birthdate, or Gender, or if you do not have internet access.
If you are enrolled in an Alberta K-12 school, please contact your school office to update your Name, Birthdate, Gender,
Address, Phone, or Email information.
Student Personal Information (Please PRINT clearly)
Surname (Last Name)
First Name
Middle Name(s)
Previous Names (if applicable)
Date of Birth (yyyy/mm/dd)
Gender
Male
Female
X unspecified
Phone Number
Cell Number
Current Mailing Address
Email Address (will be used for myPass access)
Province
Postal Code
The following information is REQUIRED to update your student record
Indicate what is to be updated on your student record
Address, Phone number and Email can be updated in myPass.
Name (provide a marriage certificate if updating to a married surname)
Address
Date of Birth
Phone Number
Gender
Email
One or more of the following documents MUST be provided to update your record
Please check off the document(s) you are providing (only photocopy is required)
Alberta/Canadian Change of Name Certificate
Canadian Citizenship Card
Alberta/Canadian Birth Certificate
Canadian Permanent Resident Card
Alberta Driver’s/Operator’s License
Canadian Certificate of Indian Status
Alberta Identification Card
Canadian/ Foreign Passport
Alberta/Canadian Marriage Certificate
Other Government issued identification
Student Authorization
I authorize Alberta Education to collect and update my personal information contained on this form in accordance with the instructions I have provided.
I understand this request will be processed only if signed by myself (student) or an authorized person.
You can use one of the following options to submit the signed and completed form including a copy of one or more of the required
identity document(s).
Electronic submission:
Online Document Submission
Or Mail:
Alberta Education
Red Tape Reduction and Student Records
44 Capital Boulevard, 10044-108 Street NW
Edmonton, Alberta T5J 5E6
Name of last Alberta High School attended
City/Town
Last Year Attended
Last Grade Attended
The personal information is collected pursuant to section 33(c), of the Freedom of Information and Protection of Privacy Act (RSA 2000, C. F-25). This information will be used to update or
correct student personal information. Questions or inquiries regarding the collection and use of your personal information may be directed to the Student Records Representative, Red Tape
Reduction and Student Records, 44 Capital Boulevard, 10044 108 Street NW, Edmonton, Alberta T5J 5E6, or email to
StudentRecords@gov.ab.ca or by telephone: 780-427-5732 (Dial 310-0000
to be connected toll-free from outside the Edmonton area.)
Student’s Signature
Date
click to sign
signature
click to edit
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