CONSENT FOR THE USE OF REFERRER PERSONAL DATA BY CU
Under the terms of the Data Protection Act 1998 (“Act”), the General Data Protection Regulation ((EU) 2016/679)
(‘’GDPR’’) and any superseding Data Protection Legislation CU London requires your consent to use any personal data
for the purpose of the student referral scheme.
1. What data do we collect?
We would like to collect the following personal data:
Your name, email, phone number, programme and if applicable chosen start date of your course at
2. Why do we need to collect this data?
It will be used for;
• Contacting via telephone the referred candidate to establish whether they want to join CU London.
• Processing this application form
• Sending you email alerts relating to this application form
3. How long we will retain your data?
We will store your data on a secure university drive for a period of 26 weeks, for CU London internal use.
4. Your Consent
Without your express permission we cannot process your application form, meaning we will be unable to
assess or respond to your application form.
Under the terms of the Data Protection Act 1998 (“Act”), the General Data Protection Regulation ((EU) 2016/679) (‘’GDPR’’) and any
superseding legislation, I consent to CU London processing and/or sharing my data for the purpose set out above.
I understand and agree that:
a) CU London will store copies of my data on their manual and electronic systems.
b) CU London will not transfer my personal data sets to a destination outside the EU.
c) CU London will disclose my personal data securely within Coventry University Group only.
d) CU London will not disclose my data to any other 3rd party organisations not speciﬁed here, without your consent and unless
required by law within and outside of the EU.
e) CU London will dispose my data securely in accordance with the Act, after the retention period speciﬁed above.
Your data will be used for the following purposes. Please indicate your consent accordingly:
I agree to my data being used for processing this application/form - Yes / No
I agree to my data being used to send me email alerts relating to this application/form - Yes / No
I agree to my data being used for analysing, within CU London, outcomes speciﬁcally in relation to this scheme - Yes / No
I also understand that I can withdraw my consent at any time by contacting firstname.lastname@example.org.
Name of Referrer:
Signature of Referrer:
In the alternative if you are unable to provide your physical signature above then you may tick the box below on the basis that you
accept by ticking the box you are providing your consent to the CU London to use your personal data for the purpose above in
accordance with the Act.
Name (please print)____________________________ Date________________________
For CU Use
Member of staff responsible for obtaining information and consent for use of student personal data:
Signed: …………………………………………… Date: ………………………………………..