Fillable GDPR%Subject%Access%Request% Form% The%use%of%this%form%is%limited%to%EEA%Personal%Data.% Part%A.%Your%information% (Tufts University)

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GDPR%Subject%Access%Request% Form% The%use%of%this%form%is%limited%to%EEA%Personal%Data.% Part%A.%Your%information% (Tufts University)

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The GDPR%Subject%Access%Request% Form% The%use%of%this%form%is%limited%to%EEA%Personal%Data.% Part%A.%Your%information% (Tufts University) form is 8 pages long and contains:

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  • 6 check-boxes
  • 40 other fields

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GDPR%Subject%Access%Request% Form%
The%use%of%this%form%is%limited%to%EEA%Personal%Data.%
Please provide the information below and return the form to Tufts’ Data Privacy Team. Details
on how to return this form are provided below. While you are not required to provide all of the
information requested below, including answers to our questions will help us give you an
accurate and prompt response to your inquiry.
Part%A.%Your%information%
Name (First, Last
and Middle)
Home Address
Campus Address
(if applicable)
Telephone number:
Email address
(please use
@tufts.edu address
when available)
Student or Employee
ID number
(if applicable)
Other name by
which you have
been known
(if applicable)
Your relationship(s)
to the University
Part%B.%Your%Request%
Please select below the type of request you wish to make. For each request, please provide a
description of your request, and any further information that will enable us to locate your EEA
Personal Data. Continue on additional pages if necessary and provide any additional
documentation that may be helpful in responding to your request.
Requests are limited to EEA Personal Data.
The right of access.
Summary: The right to request us to confirm the EEA Personal Data that Tufts processes
about you and to provide you a copy of the information. This right is subject to limitations,
including that providing a copy will not adversely affect the rights of others.
Instructions: Please note that you may currently have access to this information through your
SIS account (http://sis.uit.tufts.edu/), the Tufts online directory, see
(https://whitepages.tufts.edu/faq.cgi), or your Employee Self Service (eServe) account.
Based on what you are able to include, please provide the following information.
Description of the EEA
Personal Data. Indicate
the scope of the EEA
Personal Data you are
seeking access to.
Your relationship and
this data’s relationship
to the EEA
The offices,
departments and
databases or systems
that you believe may
have this information
The dates or time
periods when you
believe Tufts received
this information
The right to correct.
Summary. The right to request to have inaccurate EEA Personal Data rectified, or, taking into
account the purposes of the processing, completed if it is incomplete.
Instructions. In many cases, Tufts provides a procedure for you to update or correct your
information directly or to request a correction of information. For Faculty and Staff, please
see AccessTufts at Update my Information. If you are a student and depending on the
information you wish to correct, you may be able to do so using your SIS account
(http://sis.uit.tufts.edu/). For Tufts’ online directory, see https://whitepages.tufts.edu/faq.cgi.
Based on what you are able to include, please provide the following information. Also,
provide information to support your request so that corrections or additions may be made
accurately. Attach any documents that would be useful.
General description of
the type of EEA
Personal Data
Your relationship and
this data’s relationship
to the EEA
The offices,
departments and
databases or systems
that you believe may
have this information.
Current incorrect or
incomplete information
Corrected or complete
Information
The dates or time
periods when you
believe Tufts received
this information.
The reasons you are
making this request
The right to erasure (also known as the right to be forgotten).
Summary: The right for individuals to request to have their EEA Personal Data erased in
certain limited circumstances. This right is not absolute and you must satisfy one of the
requirements set forth in Article 17 of the GDPR (at GDPR Article 17) Tufts is entitled to
keep, maintain and process the EEA Personal Data in order to satisfy its legitimate interests
as legally permitted under the GDPR and under Tufts’ EEA Privacy Statement and its
Records Retention Schedules.
Instructions: Based on what you are able to include, please provide the following
information.
Description of the EEA
Personal Data. Indicate
the scope of the EEA
Personal Data you are
seeking to be erased.
Your relationship and
this data’s relationship
to the EEA
The offices,
departments and
databases or systems
that you believe may
have this information
The dates or time
periods when you
believe Tufts received
this information
The reasons you are
making this request
The right to restrict processing.
Summary: The right to request the restriction or suppression of your EEA Personal Data.
This is not an absolute right and only applies in certain circumstances. If processing is
restricted, Tufts would not be permitted to use the data without your consent, unless in
connection with a legal claim, the protection of another person, or other exceptions. Tufts
would be permitted to continue to store the information.
Instructions. Based on what you are able to include, please provide the following
information. You may also attach any documents that would be useful in responding to your
request.
The specific EEA
Personal Data that you
are requesting Tufts to
stop processing
Your relationship and
this data’s relationship
to the EEA
The offices,
departments and
databases or systems
that you believe may be
processing this
information
The dates or time
periods when you
believe Tufts received
this information
The reasons you are
making this request to
restrict processing
The right to data portability.
Summary. The right to data portability allows you to obtain an electronic copy of your EEA
Personal Data to enable you to reuse that data for your own purposes across different
services. This right allows you to move, copy or transfer EEA Personal Data easily from one
IT environment to another. This right only applies to information you have provided to Tufts
and depending on the context, applies to some of your information, but not to all of your
information.
Instructions: In many cases, you may obtain an electronic copy of your EEA Personal Data
directly by downloading your information through your account on a Tufts system.
To request a transcript from your school, we recommend you contact the Registrar’s office at
your school. To request a copy of your personnel record, we recommend you review the
information at Statement on Personnel Records, which includes a form to submit to request
your personnel record.
Based on what you are able to include, please provide the following information.
Specific description of
the EEA Personal Data
you wish an electronic
copy of
Your relationship and
this data’s relationship
to the EEA
The offices,
departments and
databases or systems
that you believe may
have this information
The dates or time
periods when you
believe Tufts received
this information
The reasons you are
making this request
The right to object.
Summary. The right to object to the processing of EEA Personal Data in certain
circumstances, in the absence of a compelling reason for the continued processing. You have
an absolute right to stop your EEA Personal Data from being used for direct marketing.
Instructions. Based on what you are able to include, please provide the following
information.
The specific EEA
Personal Data that you
are objecting to Tufts
processing
Your relationship and
this data’s relationship
to the EEA
The offices,
departments and
databases or systems
that you believe may be
processing this
information
The dates or time
periods when you
believe Tufts received
this information
The reasons you are
objecting to processing
of the data
Part%C.%Proof%of%Identity%
In order to make a Subject Access Request and to protect your personal information, you must
first provide the University proof of your identity. Please send a copy or scan of one form of
government-issued photo identification (e.g. Passport, Driver’s License) along with this request
form. If you have difficulty supplying this documentation, please contact us to discuss alternative
proof of identity arrangements. If the University is unable to verify your identity from the
documentation you provide, we will contact you as soon as possible.
Part%D.%Declaration%
I represent and warrant, under the penalties of perjury, that I am the Data Subject named in Part
A of this document, requesting information regarding EEA Personal Data that is related to my
presence in EEA or was collected from me during my presence in EEA, and hereby request,
under the provisions of the GDPR, that Tufts University respond to the request set forth above. I
certify that all of the information I have provided above is true and correct.
Signature: …………………………………………………………………………
Date: ………………………………………………………..............................
Please return signed form and accompanying documentation to:
Data Privacy Team at Tufts University
dataprivacy@tufts.edu
Data Privacy Team
Office of Information Security
Tufts Technology Services
169 Holland Avenue
Somerville, MA 02144
For information security reasons, do NOT send this form from any email address other
than from your name@tufts.edu address. Instead, please send a message to the email
address provided above that you wish to submit this form. You will then receive an email
message and instructions enabling you to submit the form through Tufts’ encrypted email
service.
Alternatively, submit the form by regular or priority mail or by an overnight courier.
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GDPR%Subject%Access%Request% Form% The%use%of%this%form%is%limited%to%EEA%Personal%Data.% Part%A.%Your%information% (Tufts University)

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Completed 24 July 2020

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