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INSTRUCTIONS TO COMPLETE THE REQUEST FOR
ALBERTA STUDENT PERSONAL INFORMATION CHANGE
1. Carefully read the instructions before completing the form
2. Please PRINT clearly in blue or black ink
3. Completion of all sections is mandatory
It will take up to 3 business days to have your record updated. Options to
submit the completed and signed form are:
Scan & E-mail: [email protected]
Fax: 780 427-4708 (Toll free outside of
Edmonton within Alberta first dial 310-0000)
Mail: Alberta Education
44 Capital Boulevard, 2nd Floor
10044-108 Street NW
Edmonton, Alberta T5J 5E6
Request for Alberta Student
Personal Information Change
The personal information as defined in the Freedom of Information and Protection of Privacy Act (FOIPP Act) that is collected on this form is collected pursuant to
section 33(c) of the FOIPP Act. The purpose of this collection is to enable Alberta Education to update or correct student personal information and address in
accordance to the information provided. Any collection of this information may be directed to Student Records, Alberta Education, 44 Capital Blvd, 10044-108 St. NW,
Edmonton, Alberta, T5J 5E6, Telephone (780) 422-9337 or Toll free outside of Edmonton within Alberta by first dialing 310-0000.
A. Student Personal Information (Please PRINT)
Surname (Last Name)
Given Name(s)
Previous Names (if applicable)
Date of Birth (yyyy/mm/dd)
Alberta Student Number
Gender
Phone Number
Email Address
Province
Postal Code
Current Mailing Address
City/Town
B. The following information is REQUIRED to update your student record
Name of last Alberta High School attended
City/Town
Last Year Attended
Last Grade Attended
C. 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 when mailing)
□ Legal Name Change
□ Citizenship Card
□ Birth Certificate
□ Permanent Resident Card
□ Marriage Certificate
□ FNMI Status Card
D. 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.
Student’s Signature
Date
If student is over 18, the person requesting for the change of ‘Student Personal Information’ on the student’s behalf must provide
proof of identification (parent, guardian or legal representative) and a copy of a power of attorney or a letter of authorization signed
by the student.
Name
Relationship
Signature
Date
Submit Signed and Completed Form to:
Alberta Education
nd
44 Capital Boulevard, 2 Floor
10044-108 Street NW
Edmonton, Alberta T5J 5E6
For Office Use Only
□ Driver’s License
Initials
□ Birth Certificate
Phone:
Fax:
Toll free:
E-mail:
Phone Number
780 422-9337
780 427-4708
310-0000 (outside Edmonton within Alberta)
[email protected]
□ Passport
□ Vital Statistics
Date
□ Other