Access/Correction Request

Freedom of Information and Protection of Privacy

Request for:
Access to General Records
Access to Own Personal Information
Correction of Own Personal Information
Name of Institution request made to:
If request is for access to, or correction of, own personal information records:
Last name appearing on records:   same as above     or     
Details:
Last Name

First Name

Middle Name

   Mr.    Mrs.
   Ms.    Miss.
Address (Street/Apt. No./P.O. Box No./R.R. No.)

City or Town
Province
Postal Code

Telephone Number(s)      Area Code
                        Day        |       |
                      Area Code
   Evening       |       |
Detailed description of requested records, personal information records or personal information to be corrected. (if you are requesting access to, or correction of, your personal information, please identify the personal information bank or record containing the personal information, if known)












Note: If you are requesting a correction of your personal information, please indicate the desired correction and, if appropriate, attach any supporting documentation. You will be notified if the correction is not made and you may require that a statement of disagreement be attached to your personal information.
Preferred method of access to records
       Examine Original
       Receive Copy
Signature


  Date
     Day        Month         Year
                |             |
For Institution Use Only
Date Received
    Day          Month       Year     
                |              |
    Request Number              


    Comments
Personal information contained on this form is collected pursuant to Freedom of Information and Protection of Privacy legislation and will be used for the purpose of responding to your request. Questions about this collection should be directed to the Freedom of Information and Privacy Coordinator at the institution where the request is made.