"Voluntary Consent Form" - British Columbia, Canada

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Download "Voluntary Consent Form" - British Columbia, Canada

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Voluntary Consent
Form
Freedom of Information and Protection of Privacy Act
Under the
, a public body may disclose personal
information only if the individual whom the information pertains has identified the information and consented,
in writing, to its disclosure.
If you wish to give your representative access to your personal information, please complete the statement
below.
The signed release must include your name, to whom you wish us to release information, for what purpose, the
validity period of the consent, and your signature.
VOLUNTARY CONSENT STATEMENT
I,
, the undersigned herewith authorize
(Please Print)
, permission to access information
(Name of Representative)
pertaining to my certification file at the Ministry of Education for the purpose of
This authorization is valid: From
(YYYY/MM/DD)
To
(YYYY/MM/DD)
Signature
Date
(YYYY/MM/DD)
File No. (Certificate No.)
August 2019
Ministry of Education
Mailing Address:
Telephone: 604 660-6060
400-2025 West Broadway
Toll Free: 1 800 555-3684
Vancouver BC V6J 1Z6
Email: trb.certification@gov.bc.ca
Voluntary Consent
Form
Freedom of Information and Protection of Privacy Act
Under the
, a public body may disclose personal
information only if the individual whom the information pertains has identified the information and consented,
in writing, to its disclosure.
If you wish to give your representative access to your personal information, please complete the statement
below.
The signed release must include your name, to whom you wish us to release information, for what purpose, the
validity period of the consent, and your signature.
VOLUNTARY CONSENT STATEMENT
I,
, the undersigned herewith authorize
(Please Print)
, permission to access information
(Name of Representative)
pertaining to my certification file at the Ministry of Education for the purpose of
This authorization is valid: From
(YYYY/MM/DD)
To
(YYYY/MM/DD)
Signature
Date
(YYYY/MM/DD)
File No. (Certificate No.)
August 2019
Ministry of Education
Mailing Address:
Telephone: 604 660-6060
400-2025 West Broadway
Toll Free: 1 800 555-3684
Vancouver BC V6J 1Z6
Email: trb.certification@gov.bc.ca