Lawrence S. Bloomberg Faculty of Nursing

Consideration of Extenuating Circumstances in the Clinical Placement Process

Form

Personal Information

• Form

  Request for Consideration of Extenuating Circumstances

• Personal Information Statement

  The University of Toronto respects your privacy. The information on this form is collected pursuant to section 2(14) of the University of Toronto Act, 1971. It is collected for the purpose of administering admission, registration, academic programs, university-related student activities, activities of student societies, financial assistance and awards, graduation and university advancement, and for the purpose of statistical reporting to government agencies. Your IP address and browser version are collected for Information Technology troubleshooting, as may be required. At all times, all data is protected in accordance with the Freedom of Information and Protection of Privacy Act. If you have questions, please refer to www.utoronto.ca/privacy OR contact the

  University’s Freedom of Information and Protection of Privacy Office at 416 946-5835,
  Room 104, McMurrich Bldg.,
  12 Queen’s Park Crescent West,
  Toronto, ON, M5S 1A8.

  I agree to have the information in this form plus my IP address and browser version be collected and stored electronically and I understand it will be protected in accordance with the Freedom of Information and Protection of Privacy Act. I understand that the information will be shared and viewed only by those who need to know. I also understand this form will be retained based on the University’s best practice guidelines for records retention, after which it will be destroyed in accordance with Information Technology Security best practices.

• Data Collected

  The following data is collected on this form

  Other Data Collected

  This data is automatically collected by the system for the purpose of Information Technology administration and trouble shooting, as may be required and for summary-level only website statistical reporting:

  Browser Type

  Browser Version

  IP Address (does not identify you)

  Hardware and operating system (reported on an aggregate level)

  Country/city of origin (reported on an aggregate level)

  Session duration (reported on an aggregate level)