Part 1 -Access to Information Request

Office of the Chief Privacy Officer 140 Weymouth St. Charlottetown, PE C1A 4Z1


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Referenced from: Access to Information and Protection of Personal Information Policy

Document text

Office of the Chief Privacy Officer 140 Weymouth St. Charlottetown, PE C1A 4Z1

Part 1 -Access to Information Request

 Access to general records
 Access to own personal information

Part 2 - Requester’s Information

Family Name *

First and middle name(s) *

Unit/Apt.no

Street no. *

Street name *

PO Box

City *

Province *

Postal Code *

Home phone no.

Work phone no.

Cell phone no.

E-mail address

Part 3 - Description of Records

Provide as much detail as possible about the relevant records

a) Time period of records dated from ___________________ (yyyy/mm/dd) to __________________ (yyyy/mm/dd ) *
b) Location of Search for Records: (please specify where records might be located, i.e. faculty, service, department, etc.): *
c) Description: *

Part 4 - Payment and signature

PLEASE ENCLOSE A $5.00 APPLICATION FEE WITH EACH REQUEST.

 Cheque (please make your cheque payable to Holland College)
 Cash
 Money Order

________________________________________________________

Signature

Date (yyyy/mm/dd)

* REQUIRED FIELD

PLEASE SEND YOUR COMPLETED FORM AND APPLICATION FEE TO THE ADDRESS ABOVE. THANK YOU.

The personal information requested on this form is collected under the authority of Section 31(c) of the PEI Freedom of Information and Protection of Privacy Act and will be used for the purpose of responding to access requests. Questions about the collect ion or use of this information should be directed to Holland College’s Chief Privacy Officer at privacy@hollandcollege.com or 902-566-9542, 140 Weymouth Street, Charlottetown, PE, C1A 4Z1.

Access Request Form

Source: https://sam.hollandcollege.com/shared/QMS/Forms/QF151-200/QF175.pdf