Change of Agent Representation Request

This form is to be used by a Durham College applicant who wishes to changes their official agent representation. This form is only to be completed by the student, and cannot be completed or submitted by the agent.

A change of agent representation may only be requested prior to payment of tuition. Once a tuition payment has been made, Durham College will not process the request.

Student Information

Name(Required)

First Last

Student Number (100xxxxxx)(Required)

Email Address(Required)

Please use the same email address which you used to apply to Durham College, or your DC mail email address.

Country(Required)

Have you paid your tuition?(Required)

Yes

Your request cannot be processed. A change of agent representation may only be requested prior to payment of tuition. Once a tuition payment has been made, Durham College will not process the request.

Agent Information

Original Agent(Required)

New Agent(Required)

Reason for Changing Agent(Required)

Has the original agent been notified that you will no longer by using their services?(Required)

Yes

Consent(Required)

By clicking this button, as the student, I confirm all information indicated, and uploaded on this form is accurate. I also authorize Durham College to notify both the original agent and the new agent if required of the change of agent status.

CAPTCHA

Notice of Collection: In accordance with Section 39(2) of the Freedom of Information and Protection of Privacy Act, 1990, the personal information collected on this form is collected under the legal authority of the Ontario Colleges of Applied Arts and Technology Act, 2002 and may be used and/or disclosed for use with Strategic Enrolment Services. Your personal information may also be used for various administrative, statistical and/or research purposes of the College and/or ministries and agencies of the Government of Ontario and the Government of Canada. If you have any questions about the collection, use and disclosure of your personal information by the College, please contact the Freedom of Information and Protection of Privacy Coordinator, 2000 Simcoe Street North, Oshawa, ON, L1G 0C5, 905.721.2000 ext. 3292.