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Freedom of Information - Consent to Release Form

I hereby authorize Northern College to give out only the information designated below:

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Referenced from: Student Services

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Northern

COLLEGE

Freedom of Information - Consent to Release Form

I hereby authorize Northern College to give out only the information designated below:

INITIALS

  1. My local address and telephone number (for emergency purposes only) .

  • a.

  • Specifically: _________________________________

  1. My permanent home address and telephone number (for emergency purposes only) .
  • a. Specifically: _________________________________
  1. My academic records to my immediate family.
  • a. Specifically: _________________________________
  1. My academic records to other post-secondary institutions.
  • a. Specifically: _________________________________
  1. My academic records and field placement report to prospective employers.

a.

Specifically: _________________________________

  1. My academic records and placement test results to my sponsor.

a.

Specifically: _________________________________

  1. My financial records/account balance and payment history to my immediate family.
  • a. Specifically: _________________________________
  1. My financial records/account balance and payment history to my sponsor.
  • a. Specifically: _________________________________
  1. and/or publicity purposes.

  • I approve of my photograph and/or my testimonial being used for college promotional

  • a. Specifically: _________________________________

  1. Others - specify:

a.

b.

  1. I authorize Northern College, the Ministry of Colleges, Universities, Research Excellence and Secuirty, and/or their agent(s) to contact future employers for survey purposes.
  • a. Specifically:

_________________________________

FREEDOM OF INFORMATION AND PROTECTION OF INDIVIDUAL PRIVACY ACT

The information on this form is collected under the legal authority of the Colleges’ and Universities’ Act R.S.O. 1980, C272, S5, R.R.O. 1980, reg. 640.

The information is used for administrative and statistical purposes of the College and/or the ministries and agencies of the government of Ontario and the government of Canada. For further information, please contact the Registrar’s office.

I have read the above statement and hereby authorize the release of information contained herein to the aforementioned.

______________________________

Student Name (print clearly)

______________________________

Date

______________________________

Student Signature

EXPIRY DATE: This release is valid until revoked in writing or the following date as determined by me:

PLEASE

RETURN THIS FORM TO STUDENT SERVICES.

Source: https://www.northerncollege.ca/uploads/2025/08/Freedom-of-Information-Consent-Form.pdf