EmailMeForm
CHANGE OF AGENT FORM
*To be completed by the student*
Student Information
Last Name:
Middle Name:
First Name:
Current Application Number:
Date of Birth: (Month, Day, Year)
MM
/
DD
/
YYYY
Current Agent Information
(If applicable – only complete if you are currently working with an agent)
Original Agency Name:
Original Agent Consultant Name:
Telephone Number:
Email Address:
*Describe reason for changing agents (if applicable – only complete if you are currently working with an agent):
New Agent Information
(*Mandatory*)
Agency Name:
Agent Consultant Name:
Telephone Number:
Email Address:
Have you notified your original agent that you are no longer working with them? (if currently working with an agent)
Yes
No
By submitting this form, you give Canadore College permission to share details of this form to both your original and new agent if required.
