By submitting this form you hereby authorise the Department of
Biochemistry to prepare a Declaration/Change of Academic Program
form on your behalf and to submit that form to the University
Memorial University protects your privacy and maintains the confidentiality of your personal information.
The information requested on this form is collected under the authority of the Memorial University Act (RSNL 1990 Chapter M-7) and is needed to
process your application for admission, to verify your qualifications and determine your eligibility for admission; for administration of student records,
scholarships, and awards; for provision of student and alumni services; and for university planning and research. Upon registration at Memorial University,
this information will form part of your student record and will be used to document your progress in an academic program. Studentsí personal information
may be disclosed to academic and administrative units, to federal and provincial agencies as legally required, to student governance associations, and
to private health insurance provider(s) as necessary to administer the applicable student health insurance program. For details on the use and disclosure
of studentsí personal information, please contact the Biochemistry General Office at (709) 737-8530.