Change of Contact Details

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Change of Contact Details Form

Given Name(s): *

Surname:

Student Number: *

Date of Birth (mm/dd/yyyy) *

I am a: *

Domestic Student

International Student

I am currently studying a: *

VET course

HE course

I am updating my: *

Phone Number	Home Address	Postal Address	Email Address	Name
Emergency Contact

Please provide us with your new details here

Street Address *

Suburb *

State *

Post Code *

Postal Address *

Suburb *

State *

Post Code *

My new email *

My new phone number: *

Updated First Name:

Updated Surname:

Please provide us with change of name documentation (e.g. drivers license, marriage certificate) *

Emergency Contact's First Name *

Emergency Contact's Last Name *

Emergency Contact's Email *

Emergency Contact's Phone Number: *

Please Note: After clicking the Submit button below you should see a Success Page if your form has been successfully submitted. Please print this page or record the reference number. If you do not see this page, please contact us to confirm that your application was received: info@ac.edu.au

Date (dd/mm/yyyy) *