This form is only for students who have already been admitted to Memorial University.
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
Privacy Notice: 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. Students' 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 students' personal information, please
contact the Biochemistry General Office at (709) 864-8530.
230 Elizabeth Ave
St. John's, NL A1B 3X9 CANADA
Tel: (709) 864-2530
Fax: (709) 864-2552