Amendment to Personal Details

Student details
Student Identification Number *
First name *
Surname *

Phone / Mobile
Campus *	Broome Fremantle Sydney
Are you a student visa holder	Yes No
Change of name

Previous First name *
Previous Middle name
Previous Surname *

New Firstname *
New middle name
New Surname *
Please attach a certified copy of a relevant document which authenticates your name change.
Supporting documentation type *	Deed Poll Marriage Certificate Statuatory Declaration Other


Relevant document *
Additional document/s
Declaration
Declaration *	I declare that the information provided is true and correct

If you experience any problems or have any questions regarding this form, please contact Student Administration:

Fremantle
Ph: (08) 9433 0781
E: student.admin@nd.edu.au

Sydney
Ph: (02) 8204 4418
E: student.admin@nd.edu.au

The information provided in this form will only be used for the administrative or educational purposes of the University, or in accordance with your specific consent. The University will not disclose your personal information to a third party unless required to or permitted by law or where you have consented to the disclosure. Information relating to how the University collects, uses or discloses your personal information and how you may complain about the University’s handling of your personal information is contained in the University’s Privacy Policy.
You have a right to access your personal information that the University holds about you and to seek its correction. If you wish to access your personal information or inquire about the handling of your personal information, please contact Student Administration at student.admin@nd.edu.au