Consent to Disclose Personal Information for Clinical Placement Program
Centennial College (“Centennial”) has entered into an agreement with ParaMed Inc. (“ParaMed”), which provides information technology services (“Requisite Record Clearance and Management Services” or “Requisite”) that facilitate the collection, organization and reporting, on behalf of students, of information about their satisfaction of the criteria for participation in clinical placement programs (“Program”).

Centennial’s role is limited to providing your Registration Information to ParaMed and your Final Clearance Status to the organization providing your Program. Centennial’s access to the personal information compiled or created about you by ParaMed is restricted to the information that you have met or failed to meet the criteria for your Program (“Final Clearance Status”).

Centennial is subject to the Freedom of Information and Protection of Privacy Act (Ontario) and collects personal information under the authority of subsection 2(2) of the Ontario Colleges of Applied Arts and Technology Act, 2002. Centennial is required to obtain your consent to the disclosure of your personal information for the purpose of your participation in the Program. By signing this form, you are consenting to Centennial disclosing:

1. your name, student number, Centennial student email address, program code and name, and year or semester of study (“Registration Information”) to ParaMed; and

2. your Final Clearance Status to the organization providing your Program.

Centennial will also understand from your signature on this form, that you have consented to Centennial receiving and using your Final Clearance Status for the purpose of your participation in the Program.

Centennial has no responsibility and will accept no liability for any use or disclosure that ParaMed makes of your personal information. You should direct any questions or concerns about ParaMed’s privacy policy and practices and its use or disclosure of your personal information to ParaMed. You will be responsible for all of ParaMed’s fees in connection with your use of Requisite.

If you have any questions in connection with Centennial’s collection, use or disclosure of your Registration Information and Final Clearance Status, please contact us at placementrequirements@centennialcollege.ca and your queries will be dealt with accordingly.

Note: Only one submission required.
First Name *
Last Name *
Student Number *
Program of Study *
Program Code *
Centennial College Email *
I Consent to Disclose Personal Information for Clinical Placement Program. *Write your First and Last Name to Agree to the terms. *
Date *
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