Privacy Notification
Thompson Rivers University (TRU) collects, uses, discloses and retains personal information in compliance with the BC Freedom of Information
and Protection of Privacy Act (the FIPPA). Your personal information is being collected on this form under Section 26(c) of the FIPPA for the
purpose(s) of obtaining your consent to release your personal information to the identified third party(ies) as required under Section 33.1(b).
Questions about this privacy notice can be directed to the Privacy Officer at privacy@tru.ca, or by calling 250-828-5012, or by post to:
TRU Privacy Office, 805 TRU Way. Kamloops, BC V2C OC8.
This form will be kept on file in compliance with TRU’s Records Retention Policy.
Consent to Release Personal
Information Form (Third Party)
PART I - STUDENT INFORMATION
I authorize (print name of person/agency here) ________________________________________
access to the following information:
£ Academic status
£ Convocation information
£ Enrolment status information
£ Grades
£ Registration information (including current registration status)
£ Special needs documentation/Disability accommodations
£ Other (specify) _________________________________________________________________
PART II - FINANCIAL INFORMATION
I authorize (print name of person/agency here)________________________________________
access to the following information:
£ Student account balance
£ Student awards
£ Student loan information
£ Tuition and fees assessment
£ Other (specify) _________________________________________________________________
PART III - STUDENT TRANSACTIONS
I authorize (print name of person/agency here)
____________________________________
to carry out the following transactions on my behalf:
£
Add/drop courses
£
Pay fees
£
Order transcripts, confirmation of enrolment leers, signed scholarship/RESP forms
£ Other (specify) _________________________________________________________________
PART IV - DURATION
This waiver will be valid for the following period:
From: Date (yyyy/mm/dd)
______________________________________________________
To: Date (yyyy/mm/dd)
________________________________________________________
PART V - SIGNATURE
Student records are confidential and are not changeable without the wrien consent of the student, unless otherwise required by law. Your
signature indicates that you are requesting your records be revised and that information contained herein is accurate to the best of your
knowledge. TRU considers a falsified consent form as fraud.
STUDENT SIGNATURE
DATE (yyyy/mm/dd)
DATE (yyyy/mm/dd)
OFFICE USE ONLY
RECEIVED BY DATE ENTERED (yyyy/mm/dd)
IMPORTANT!
Access to online fee payment and registration services is controlled through each student’s T-ID and password. It is the responsibility of each
student to control access to their password. Under no circumstances will a student’s password be released to a third party, even in cases where
this consent has been signed.
TRU STUDENT NUMBER
STUDENT PERSONAL DATA (PRINT CLEARLY)
FIRST NAME (legal) FULL MIDDLE NAME(S) (legal) DATE OF BIRTH (yyyy/mm/dd)
Enrolment Services
805 TRU Way
Kamloops, BC, Canada V2C 0C8
tru.ca
Campus students: records@tru.ca
Open Learning students: student@tru.ca
3rd PARTY PERSONAL DATA (PRINT CLEARLY)
ADDRESS EMAIL (optional)
PHONE
ENR19004
SURNAME (legal)
SURNAME (legal), FIRST NAME or AGENCY
click to sign
signature
click to edit
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