Fillable 2018 Access To Information Form %28fillable%29 0 - 2018_access to information form

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2018 Access To Information Form %28fillable%29 0 - 2018_access to information form

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Freedom of Information and Protection of Privacy:
Access/Correction Request Form
Access to Information and Correction of Personal Information Process:
The University of Guelph Access/Correction Request Form may be used to request the following information
under the
Freedom of Information and Protection of Privacy Act
:
Access to General Records
Access to Personal Information
Correction of Personal Information
Please note: all requests for personal information will require proof of identification before information can be
released.
Application Fee:
Requesters must submit a completed and signed Access/Correction Request Form along with a
$5.00 application fee for each separate request.
Cheques and money orders should be made payable to the University of Guelph.
There is no application fee to request a correction of your own personal information.
Submitting a Request:
Submit completed request forms and application fees by mail to:
University Secretariat
University Centre, 4
th
Floor
50 Stone Road East
Guelph, Ontario
N1G2W1
Upon receipt of the completed Access/Correction Request Form and $5.00 application fee, a staff member
from the University Secretariat will contact you outlining the next steps of the process.
For questions related to completing an access/correction request, or general inquiries regarding access and
privacy at the University of Guelph, please contact the University Secretariat at fippa@uoguelph.ca.
Freedom of Information and Protection of Privacy: Access to Information and Correction Request Form
Part 1: About the Requester
Mr. Mrs. Ms. Miss Dr. N/A
Last Name: First Name:
Address:
City: Postal Code: Province:
Email Address: Phone:
Part 2: About the Request
Provide a detailed description of requested records, personal information, or personal
information to be corrected. If you are requesting access to, or correction of, your own personal
information, please include your date of birth and identify the Personal Information Bank (PIB) or record
containing the personal information, if known, as well as the last name appearing on the records if different
from above. If you are seeking a correction to 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 request that a statement of disagreement be attached to your personal information.
Request for:
Access to General
Records
Access to Personal
Information
Correction to Personal
Information
Request time span:
Location of records:
Request:
Preferred method of access to records: Examine Original Receive Copy
Part 3: Your Signature
Signature: Day: Month: Year:
Personal inf
ormation on this form is collected under the authority of the University of Guelph Act, 1964 and in
accordance with Ontario’s Freedom of Information and Protection of Privacy Act. This information will be used
for the purpose of responding to your request. Questions about this collection should be directed to the
University’s privacy officer, University Secretariat, 519-824-4120 x.56571 or by email to fippa@uoguelph.ca.
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2018 Access To Information Form %28fillable%29 0 - 2018_access to information form

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Completed 30 April 2020

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