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Consent For Release
Consent for Release of Personal Information
Pursuant to Section 42(b) of the Freedom of Information and Protection of Privacy Act, “an institution shall not disclose personal information in its custody or under its control except, (b) where the person to whom the information relates has identified that information in particular and consented to its disclosure”.
authorise Conestoga College Institute of Technology and Advanced Learning to relese the following personal information:
this information may be released to :
All fields are mandatory ; failure to provide all required information will result in non-processing of this request
This authorization is valid for :
From the date of the signature
Four digit numerical security Code
This Code must be provided for information to be released.
OEN (If known)
Print, sign (student and witness ), scan and attach this form here
Freedom of Information The personal information collected on this is used for administrative purposes of the Registrar's Office under the authority of the Ontario Colleges of Applied Arts and Technology Act, R.S.O 2002, and regulations thereunder. Personal information will be protected in accordance with the Freedom of Information and Protection of Privacy Act (FIPPA).