Personal Information Consent to Publish Form The personal information requested on this form is collected under the authority of the Carleton University Act in accordance with Section 38(2) and 42(1) of the Freedom of Information and Protection of Privacy Act (FIPPA). The information provided will not be used for any purposes other than those stated upon this form unless the individual consents otherwise. Carleton University is fully compliant with FIPPA and endeavours at all times to treat your personal information in accordance with this law. For any questions concerning personal information, please contact the academic unit’s Administrator (Dawn Schmidt, dawn.schmidt@carleton.ca, 613 520-2600, ext. 2177) and/or the University Privacy Office (University_Privacy_Office@carleton.ca, 613 520-2600 ext. 2047) This information will be retained and disposed of in accordance with approved records retention and disposal schedules of the University. Name* First Last Student Carleton Email* Date* Date Format: MM slash DD slash YYYY Consent Checkbox* By checking the above box, I hereby grant explicit consent to Carleton University and the Institute for Comparative Studies in Literature, Art and Culture (ICSLAC), in the person of its official FIPPA Representative, to publish my first and last name, my association with the Institute (e.g., student, alumni), my research profile and academic biography, my testimonials and photographs, for the purpose of internal and external communication and/or promotion and publicity. I understand that the personal information and image as described above may be published electronically (e.g., Institute emails, websites) or in print (e.g., event posters and Institute brochures) in the form of congratulatory notices (e.g., awards, program milestones, graduation notices), news and event postings (e.g., awards, exhibition) or Institute documentation ( e.g., program viewbook, brochures). NameThis field is for validation purposes and should be left unchanged.