MITT - Consent to Release Student Information

The Manitoba Institute of Trades and Technology (MITT) collects and protects personal information under the authority of the Freedom of Information and Protection of Privacy Act (FIPPA) for the purpose of delivering its programs and services.

For more information on FIPPA, please visit: http://www.gov.mb.ca/chc/fippa/

If you need your personal information disclosed to another individual, designated agent or agency, legal counsel, or for another specified purpose, please complete the informed consent form as required under the Act.

I,Full Name*,Student Number* I hereby voluntarily authorize and consent to the release of information held by MITT, specifically information related to my demographic, application, registration, financial record and grades contained in, or as a part of, my MITT student record to the following:

Student E-mail:*

example@example.com

Do you need to designate another individual, agency, or organization?

YesNo

Do you need to designate another individual, agency, or organization?

YesNo

Please enter an expiry date for your consent. If no date is provided, your consent will expire two years from the date this form is submitted, or when MITT is notified otherwise in writing. You may withdraw your consent at any time by contacting the CSR Department.

Hidden Date Picker

Date

Consent Expiry Date*

Date

If you wish to authorize the 3rd party to access your entire record, indicate “NO EXCEPTIONS.” Otherwise, indicate any exception below (e.g.: fees, grades, attendance, etc.)

Comments/special instructions

By signing this form, I am explicitly granting access to elements of my personal/academic information to the person/organization designated on this document. I hereby agree to save harmless MITT from any present or future claims by myself, my heirs, or assigns for releasing the above information. MITT will not release student account usernames or passwords, or Tuition and Education Credit Certificates (T2202A Tax Receipts) to anyone other than the student. It is my responsibility to become familiar with MITT’s policies and read the Freedom of Information and Protection of Privacy Act (FIPPA).

I understand it is my responsibility to become familiar with MITT’s policies and read the Freedom of Information and Protection of Privacy Act (FIPPA) https://mitt.ca/privacy. MITT collects and protects personal information under the authority of the Freedom of Information and Protection of Privacy Act (FIPPA) for the purpose of operating the programs and services of the College. More information about FIPPA is at http://www.gov.mb.ca/chc/fippa.

Student Signature*