PHA Alumnus Contact Information Update

Please use this form to request changes to the email address used for your Slate login.

Required Information

First Name

Last Name

Brandeis Email Address

New Email Address (This cannot be an @brandeis.edu address.)

Optional Information

Although not required, the information below can be helpful for the Pre-Health Advising office to locate your Slate record.

Class Year

Student ID

Birthdate

Additional Information

If there is additional information you'd like to share with the Pre-Health Advising office regarding this request, please share it in the box below. (optional)