University of Essex
Data Protection Act 1998 - Subject Access Request Form
The Data Protection Act 1998 gives people the right to access their personal information. The University of Essex holds personal information on current and former staff and students. It also holds some information on those who apply unsuccessfully for jobs or places to study. 
We use the information on this form to confirm your identity. We may need to contact you to ask for more information.
Section one - Information about you
Your full name (including former names and any alternative names we might know you by)		
Your contact address
		
Your email address
		
Your phone number
		
Your date of birth
		
How would you prefer us to contact you? Post/email/phone

Complete this section if you are or were a student at Essex
Your department
		
Your student registration number
		
Your course
		
Dates you studied here 

Complete this section if you are or were a member of staff at Essex
Your department or section
		
Your payroll number
		
Dates you worked here
		
Job title
		
Complete this section if you applied for a job or place to study at Essex
Course/job applied for
		
Date applied
		
None of the above? Please explain your relationship to the University:

	
Section two - please complete this section ONLY if you are applying on behalf of another person
The Data Protection Act gives you the right to see information about you, but not about other people. However, you can ask another person to act on your behalf.
If you are asking for this information, but are not the person named in section one, please tell us who you are.
Your name
		
Your address, email and phone number
		
Your relationship to the person named in section one (e.g. lawyer, power of attorney)

If you have signed a consent from the person named in section one please include a copy with your application. We may contact you for confirmation that you have the permission of the person named in section one. 
Section three – information about what you want to see
If you are, or were, a student, we will look in Registry and your department. If you are a staff member we will look in HR and your department. If it is relevant we will also search in Finance, Accommodation, Student Support, Occupational Health, the Student Discipline Office and the Complaints Office.
Please let us know if there is a specific office you’d like us to look for information about you.

	
You can ask to see all the information we hold on you. A lot of it is likely to be quite routine. If you are looking for specific items and are happy to have copies of those rather than your entire file, please let us know.

	
Section 4 - declaration
When you sign this form you are confirming that the information you have given above is correct. You agree that we can contact you for further proof of your identity and understand that we will refuse to give you information if we cannot confirm your identity. 
Your signature:
Today’s date:
Please send this form and payment of £10 (cheques made payable to ‘University of Essex’) to: Information Manager, University of Essex, Wivenhoe Park, Colchester, Essex, CO4 3SQ

The law allows us 40 calendar days in which to respond. If you have any questions about this form or about accessing your information please contact the Information Assurance Manager on 01206 874853, e-mail: information.manager@essex.ac.uk