{"id":4210,"date":"2021-10-18T16:51:47","date_gmt":"2021-10-18T20:51:47","guid":{"rendered":"https:\/\/carleton.ca\/icslac\/?page_id=4210"},"modified":"2026-06-23T16:35:42","modified_gmt":"2026-06-23T20:35:42","slug":"personal-information-consent-to-publish-form","status":"publish","type":"page","link":"https:\/\/carleton.ca\/icslac\/forms\/personal-information-consent-to-publish-form\/","title":{"rendered":"Personal Information Consent to Publish Form"},"content":{"rendered":"\n<section class=\"w-screen px-6 cu-section cu-section--white ml-offset-center md:px-8 lg:px-14\">\n    <div class=\"space-y-6 cu-max-w-child-5xl  md:space-y-10 cu-prose-first-last\">\n\n            <div class=\"cu-textmedia flex flex-col lg:flex-row mx-auto gap-6 md:gap-10 my-6 md:my-12 first:mt-0 max-w-5xl\">\n        <div class=\"justify-start cu-textmedia-content cu-prose-first-last\" style=\"flex: 0 0 100%;\">\n            <header class=\"font-light prose-xl cu-pageheader md:prose-2xl cu-component-updated cu-prose-first-last\">\n                                    <h1 class=\"cu-prose-first-last font-semibold !mt-2 mb-4 md:mb-6 relative after:absolute after:h-px after:bottom-0 after:bg-cu-red after:left-px text-3xl md:text-4xl lg:text-5xl lg:leading-[3.5rem] pb-5 after:w-10 text-cu-black-700 not-prose\">\n                        Personal Information Consent to Publish Form\n                    <\/h1>\n                \n                                \n                            <\/header>\n\n                    <\/div>\n\n            <\/div>\n\n    <\/div>\n<\/section>\n<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar 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           <p class='gform_description'>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. \r\n<br><br>\r\nCarleton 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\u2019s 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)\r\n<br><br>\r\nThis information will be retained and disposed of in accordance with approved records retention and disposal schedules of the University. <\/p>\n                        <\/div><form class='not-prose' method='post' enctype='multipart\/form-data'  id='gform_1'  action='\/icslac\/wp-json\/wp\/v2\/pages\/4210' data-formid='1' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_1' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_1_27\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_27'>X\/Twitter<\/label><div class='ginput_container'><input name='input_27' id='input_1_27' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_1_27'>This field is for validation purposes and should be left unchanged.<\/div><\/div><fieldset id=\"field_1_1\" class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_1_1'>\n                            \n                            <span id='input_1_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.3' id='input_1_1_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_1_1_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_1_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.6' id='input_1_1_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_1_1_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_1_2\" class=\"gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_2'>Student Carleton Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_2' id='input_1_2' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_1_24\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_24'>Date<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_24' id='input_1_24' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_1_24_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_1_24_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_1_24' class='gform_hidden' value='https:\/\/carleton.ca\/icslac\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><fieldset id=\"field_1_25\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Consent Checkbox<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_25.1' id='input_1_25_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_1_25\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_1_25_1' ><\/label><input type='hidden' name='input_25.2' value='' class='gform_hidden' \/><input type='hidden' name='input_25.3' value='13' class='gform_hidden' \/><\/div><div class='gfield_description gfield_consent_description' id='gfield_consent_description_1_25' tabindex='0'>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. <br \/>\n<br \/>\nI 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). <br \/>\n<\/div><\/fieldset><div id=\"field_1_26\" class=\"gfield gfield--type-captcha 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