Request for:
Name of department request made to:
Access to General Records
Access to Own Personal Information
Correction to Own Personal Information
If request is for access to, or
correction of, own personal information records:
Last name appearing on records: same as below, or:
Mr. Mrs. Ms. Miss Last Name:
First Name: Middle Name:
Address: (Street/Apt. No./P.O. Box/R.R. No.) City/Town:
Province: Postal Code:
Telephone Number (Day): ( ) Telephone Number (Evening): ( )
Detailed description of requested records, personal information 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
person information, if known.)
Note: If you are requesting a correction of personal information, please indicate the desired correction, and if appropriate, attach any supporting
documentation. You will be notied if the correction is not made and you may require that a statement of disagreement be attached to your personal
Preferred method Examine Original Signature: Date:
of access to records: Receive Copy
Institution Use Only
Date Received: Request Number: Comments
Personal Information contained on this form is collected pursuant to the Freedom of Information and Protection of Privacy Act/Municipal Freedom of
Information and Protection of Privacy Act and will be used for the purpose of responding to your request. Questions should be directed to Seneca's
Privacy Office at 416.491.5050 extension 77846 or email
Access Request Form
under the Freedom of Information and Protection of Privacy Act
Please Note: A $5.00 application fee is required for all requests.