Fillable Exerciseof Rights UwgGDP Rfillable (West Georgia College)

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Exerciseof Rights UwgGDP Rfillable (West Georgia College)

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1
European Union General Data Protection Regulation (EU GDPR)
Exercise of Individual Rights
PURPOSE OF FORM: Individuals who provide to the University of West Georgia, either directly or
indirectly, personal data covered by the EU GDPR (“Data Subject”) may exercise certain individual
rights. If you wish to exercise any one of those rights (listed below), please indicate which right(s) you
are exercising and the desired outcome. (Note: the right to withdraw consent is handled through a
separate process. Please contact the Chief Privacy Officer (here) for the Withdrawal of Consent form.
1. Any Data Subject who wishes to exercise one of these rights under the GDPR will fill out the form
below and submit it to the Chief Privacy Officer.
2. Upon receipt of the request, the Chief Privacy Officer will determine if there could be an impact to
the requestor if the request is granted (as used herein, “impact” means any consequence to the
requestor’s participation or benefit from, without limitation, any program, services, or
employment).
3. Chief Privacy Officer will notify the requestor of any impact and the requestor will tell the Chief
Privacy Officer whether or not to continue processing the request.
4. If there is no impact, the Chief Privacy Officer will proceed to process the request.
5. UWG will authenticate all requests for the exercising of an individual right.
(Continued on next page)
2
Exercise of Individual Rights Form
INSTRUCTIONS TO DATA SUBJECTS: Check the box(es) to indicate which right(s) you wish to exercise,
and in the space provided under that check box, please list any desired outcome to assist the Chief
Privacy Officer with an understanding of your concerns.
Note: Exercising these rights is a guarantee to be afforded a process, and not the guarantee of a
favorable outcome.
Individual Rights of the Data Subject under the EU GDPR
(Select each box you wish to exercise and please give a desired outcome)
Information about the controller collecting the data
______________________________________________________________________
Data protection officer contact information
______________________________________________________________________
The purposes and legal basis/legitimate interests of the data collection/processing
______________________________________________________________________
Recipients of the personal data
______________________________________________________________________
If UWG intends to transfer personal data to another country or international organization
______________________________________________________________________
3
The period the personal data will be stored
______________________________________________________________________
The existence of the right to access, rectify incorrect data or erase personal data, restrict or
object to processing, and the right to data portability
______________________________________________________________________
The existence of the right to withdraw consent at any time
______________________________________________________________________
The right to lodge a complaint with a supervisory authority (established in the EU)
______________________________________________________________________
Why the personal data fields are required, and possible consequences of the failure to provide
the data
______________________________________________________________________
The existence of automated decision-making, including profiling
______________________________________________________________________
4
If the collected data are going to be further processed for a purpose other than that for which it
was collected
______________________________________________________________________
-----------------------------------------------------------------------------------------------------------------------------------------
SIGNATURE: __________________________________________________________________
PLEASE GIVE US CONTACT INFORMATION SO WE MAY CONTACT YOU OR YOUR REPRESENTATIVE:
[END OF FORM]
Forward a fully completed form to the Chief Privacy Officer at Legal@westga.edu, or by regular mail at:
Chief Privacy Officer (University General Counsel)
1601 Maple Street
Carrollton GA 30118.
Questions? Call (678) 839-5306
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Completed 22 July 2020

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