Appendix 1 - Statutory Declaration and Confidentiality Agreement for Access to Student Information System

I, ____________________________________________ of
               (Print Name in Full)

________________________________________
               (City or Town)                                                  

in the Province of Alberta, do solemnly declare as follows:

1. That I understand that the Office of the Registrar and Student Awards is responsible for safeguarding and maintaining the integrity of student academic records at the University of Alberta ("University");

2. That I understand that all information concerning individual students and prospective, current and former students is strictly confidential and may only be released in strict accordance with University policy and provincial and federal legislation, as amended from time to time;

3. That I undertake not to reveal any information about a student or prospective, current or former student or groups thereof to anyone, except as required in the course of my duties, during my employment; and further not to remove or disclose any information whatsoever after the completion of my employment with the University;

4. That I will not tamper with, destroy, falsify or otherwise improperly deal with any University records or files of any kind whatsoever;

5. That I will not create any false record in the University's official records. In the case of programming staff authorized to conduct system testing in the course of their duties, the condition of temporary test results is permitted;

6. That I acknowledge and agree that, if I should contravene any of the terms of this declaration, it shall constitute cause for discipline and the University reserves the right to seek prosecution of individuals committing such infractions;

7. That I have carefully read and accept this declaration.

And I make this solemn declaration conscientiously believing it to be true, and knowing that it is of the same force and effect as if made under oath.

DECLARED before me at the ___________                                          )
                              
of __________________, in the Province                                              )

of Alberta, this _________ day of                                                           )

___________________.                                                                        ) 

 

___________________________________           ______________________________
(COMMISSIONER FOR OATHS IN AND                    (signature)
FOR THE PROVINCE OF ALBERTA)"

(EXEC 27 APR 1998)