TESOL Language and Culture Outbound Project

TESOL language and culture participant information form and privacy notice statement.

Name Name First Last
Email
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Program Enrolled in
Nationality
This project was funded to support students with barriers to study abroad / outbound mobility. Selkirk College encourages you to complete the following voluntary questions.

Gender

This project was funded to support students with barriers to study abroad / outbound mobility. Selkirk College encourages you to complete the following voluntary questions.

Gender Male Female Other
Person with a disability

Person with a disability Yes No
Self-identified Indigenous

Self-identified Indigenous Yes No
Low Income

Low Income Yes No
Participate Declaration and Consent to Release Information

I, (name of applicant)
I, the undersigned named above, certify that all information provided on this form is accurate. I consent to CICan collecting this information and to the release of this information to ESDC. I acknowledge that the information is collected and administered in accordance with the Privacy Act and applicable privacy laws.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
The federal government, specifically Employment and Social Development Canada (ESDC), as funder of this virtual study/outbound mobility project through an agreement with Colleges and Institutes Canada (CICan), has provided funding to assist students with barriers to participation in study abroad. This project intends to focus on three types of students: students with disabilities, self-identified indigenous students, and students from low-income families.

Selkirk College has been asked to document some basic information about participants in the virtual outbound mobility projects (referred to as the “sub-project”).

Since funding for the project has been provided by ESDC, through CICan, the Student Experience Information may be disclosed to and used by CICan and ESDC for the following purposes:

a) to measure the results of the Sub-Project and the Project, and to evaluate the Project’s success;
b) to evaluate more generally, the success of the Program in achieving its objective; and
c) to meet their obligation of accountability to Parliament and the Canadian public for the operation of the Program by reporting on the results of the Program and its success in achieving its objective.

Selkirk College wishes to inform you and seek your consent to the following:
a) by participating in the Sub-Project, you may be subject to a longitudinal study administered either by Statistics Canada or by a Third Party contracted on ESDC’s behalf and may be contacted for that purpose;
b) to the collection, use and disclosure of the Student Experience Information for the purposes set out in section 4.3.1
c) that your participation in a survey following your participation in the Sub-Project is voluntary and whether you choose to participate will not affect your eligibility for the program;
d) that the Student Experience Information, when provided to ESDC, is administered in accordance with the Privacy Act (R. S.C., 1985, c. P21) and the Department of Employment and Social Development Canada Act (S.C. 2005, c. 34) and that you have a right under the Access to Information and Privacy Act (R.S.C., 1985, C. A-1) to obtain access and correction to that information from ESDC;
e) in accordance with the Privacy Act, if you are not satisfied with the response to your privacy concerns or if you want to file a complain under the handling of your personal information, you may wish to contact the Office of the Privacy Commissioner of Canada.
f) all Student Experience Information collected or compiled by CICan shall be treated as confidential and CICan shall take all the security measures reasonably necessary for the protection of same against unauthorized release or disclosure, including those set out in any instructions issued by ESDC.
g) CICan shall not release or disclose Student Experience Information about a student or post-secondary institution to any other person or body for any purpose unless the student or post-secondary institution consent to the release or disclosure or the person or body is authorized by law to require CICan to provide information to the person or body
h) CICan shall safeguard the Student Experience Information at all times by taking all measures reasonably necessary to secure it and protect its integrity and confidentiality. To do so, at a minimum, CICan shall:
1. Store the personal information electronically so that a password (or a similar access control mechanism, such as biometric access) is required to access the system or database in which the personal information is stored;
2. Ensure that passwords or other access controls are provided only to individuals who require access to the personal information to perform the work;
3. Safeguard any database or computer system on which the personal information is stored from external access using methods that are generally used, from time to time, by prudent public and private sector organizations in Canada in order to protect highly secure or sensitive information.
i) All paper records with Student Experience Information shall be retained by CICan for a period of six (6) years after completion of the Sub-Project. Upon expiry of the six-year retention period, electronic records shall be deleted and paper records shall be destroyed using a commercially available paper shredder, unless:
1. CICan is required by law to retain any of the Student Experience Information for a period of time beyond the period of retention;
2. CICan proves to the satisfaction of ESDC that the retention of the information beyond the period of retention is required by CICan in order to provide ongoing or future assistance to the student participating in the Sub-Project.