BRUNELUNIVERSITY

DATA PROTECTION ACT 1998 – SUBJECT ACCESS REQUEST Form

An individual is entitled to be told if data are held about them and to be supplied with a copy of such information. This applies to computerised records and some information in manual files. There is a £10 charge (£5 for current students) for each subject access request.

If you have any queries whilst completing this form, please contact the Information Access Officer, Tel 01895 265389, e-mail: .

Please complete clearly in BLOCK LETTERS.

Surname: / Forename:
Address:
Previous name used at time of contact with University:
Telephone Number:
E-mail (optional):

Please supply evidence of your identity, e.g., student ID card, driving licence, passport (or photocopy) and, if necessary, a stamped addressed envelope for returning the document(s).

INFORMATION SOUGHT
Students (current or former)
ID No.:
Name of Course 1:
Date started: / Date left:
Name of Course 2:
Date started: / Date left:
Staff (current or former)
Department (s):
Date started: / Date left:
Please describe the information you are seeking, if you only wish to see specific document(s) e.g., a particular report, a specific departmental file, academic marks.
If you would like a more general search, please tick below to indicate any Departments/Units to be searched.
(Please note that for students the University will normally automatically search the following sections for personal data: Registry, Finance, Computer Centre, Library, Accommodation, Housing, any academic department in which you have studied as part of your course.)
Section / Search / Section / Search
Security* / Safety Office
Human Resources / Alumni
Sports Centre / Brunel International
Disability & Dyslexia Service / Placement & Careers Centre
*CCTV is available; further information may be required including date(s), times(s) and location.
Other(s), please specify below:
If you wish to see information held by the Counselling Service, please contact them directly.
I certify that the information given on this application form to BrunelUniversity is true. I understand that it is necessary for the University to confirm my identity and it may be necessary to obtain more detailed information in order to locate the correct information.

Signature:

/

Date:

This form should be sent to: Information Access Officer, Office of the Secretary to Council, BrunelUniversity, UXBRIDGE UB8 3PH.
Documents which are also required with this application are:
i) evidence of your identity
ii) a fee of £10 (£5 for current students) (cheques payable to BrunelUniversity)
iii) stamped addressed envelope for proof of identity documents, where appropriate.
Please note that the University reserves the right to obscure or suppress information that relates to third parties (under Section 7 of the Data Protection Act 1998).

Office Use

Request ReceivedIdentification checked

Date completedFee Received

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