Fillable CONSENT TO PUBLISH INFORMATION (Name of faculty/staff memb (Carleton University)

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CONSENT TO PUBLISH INFORMATION (Name of faculty/staff memb (Carleton University)

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Page 1 of 3
CONSENT TO PUBLISH
INFORMATION
Part A:
To be completed by the faculty/staff member or academic/administrative unit:
_______________________ from the ____________________________________ is requesting
(Name of faculty/staff memb
er) (Academic
/Adminstrative unit)
your consent to publish your name, photograph, biography, scholarship award details, and/or
other information as described below:
This information will be published for the purposes of promotion, publicity, and/or other
purposes as described below:
This information will be published on websites, materials, and/or in other areas as described
below:
Carleton University Privacy Office: Oct 2018
Page 2 of 3
Part B:
To be completed by the faculty/staff member or academic/administrative unit:
The personal information requested on this form is collected under the authority of the
Carleton University Act in accordance with Section 38(2) and 42(1) of the Freedom of
Information and Protection of Privacy Act (FIPPA). The information provided will not be used
for any purposes other than those stated upon this form unless the individual consents
otherwise. Carleton University is fully compliant with FIPPA and endeavours at all times to
treat your personal information in accordance with this law.
Should you have any questions concerning your personal information, please contact:
FIPPA Representative:
Academic/Administrative Unit:
Telephone:
E-Mail:
Carleton University Privacy Office: Oct 2018
Part C:
To be completed by the individual:
I understand that my personal information and image may be published in hard copy
or online and I hereby provide explicit consent to publish the information detailed in
Part A on page 1 of this form.
This information will be retained and disposed of in accordance with approved
records retention and disposal schedules of the University.
____________________________
___________________
_ (Name of individual)
(Signature)
(Date: MM/DD/YYYY)
Page 3 of 3
Please direct any questions about completing this form or this issue to the:
Manager, Privacy & Access to Information
Telephone: (613) 520-2600 Ext. 2047
E-Mail: University_Privacy_Office@carleton.ca
OR the FIPPA Representative in your academic/administrative unit.
Part A: The faculty/staff member shall enter their name, the academic/administrative unit, a
description of the information to be published, a description of the purpose for publishing the
information, and a description of the location where the information will be published.
Part B: The faculty/staff member shall enter the name of the FIPPA representative for the
academic/administrative unit and the representative’s telephone extension and E-Mail
address. If no representative is available, you identify the Manager, Privacy & Access to
Information as the contact.
Part C: The individual shall indicate the personal information that may be published and shall
sign and date the form to indicate explicit consent. The student may specify a time limit
(usually 5 year) or indicate “no time limit” if the period of permission is indefinite.
Guidelines for publishing student information:
Under FIPPA, the University is not allowed to confirm or deny the enrolment of any current
undergraduate or graduate student without their consent. Posting current student names on
websites (for example scholarship winners) or academic Curriculum Vitaes (CVs) is considered
confirming enrolment and this should not be done without consent.
Posting student names on websites/academic CVs:
Implicit consent is acceptable to post undergraduate and graduate student names on
websites and/or academic CVs. A record will need to be kept, in the academic unit offices,
that students have been advised of plans to post their names. If any student objects, their
name may not be posted publicly and must be removed if already posted. The following is a
sample notice: “I am/we are planning to post your name on the following web pages…
(include the url). If you object to your name being posted, please advise the writer by return
E-Mail within 5 days. If you do not respond, your consent to post your name will be assumed.”
Posting student names/photos/biographies for publicity purposes:
Explicit consent is required to post undergraduate and graduate student
names/photos/biographies for publicity purposes. A record of consent will need to be kept for
each student as long as their personal information (i.e. name, likeness and other personal
information) is continued to be used. This Consent to Publish Student Information form may
be used for this purpose.
Carleton University Privacy Office: Oct 2018
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CONSENT TO PUBLISH INFORMATION (Name of facultystaff memb (Carleton University)

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Completed 15 April 2021

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