Student Lost Contact Form
(Source: Renfrew County School Board - used with permission)
This form
is filled out by the instructor. Students will not be recorded
as "lost
contacts" until this form is submitted.
Student's Name:_____________________________________
Do you feel this
student was high risk for leaving your program?
Yes____
No____
What steps did you take in your classroom with this
student to reduce the risk
of student's exit before attendance was an issue?
Phone
Contact:
1st Phone Contact Date:_____________
Comments: __________________________________
____________________________________________
____________________________________________
2nd Phone Contact Date:_____________
Comments: __________________________________
____________________________________________
____________________________________________
3rd
Phone Contact Date:_____________
Comments: __________________________________
____________________________________________
____________________________________________
*If
contact cannot be made by phone the form letter provided
is to be sent to the student.
Date Sent:____________ Reply
Back: Yes_____ No_____
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Lost Contact Memo
(Source: Renfrew County School Board - used with permission)
TO:
DATE:
FROM:
RE:
I have been unable to contact you by phone and would
very much appreciate it if you contact me to let me know
why you have not continued
to come to class. This will allow me to close your student
file.
Please call me at the school______________ or write
your reason on the bottom of this memo and mail it back
to me in the addressed envelope provided.
Thank you very
much.
Reason for Leaving:
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Sample Privacy Policy
(Source: Northern Connections Adult Learning Centre - used with permission)
Statement of Intent
<Name of Literacy Agency> respects the privacy of
our members, clients, volunteers, staff, donors, sponsors
and stakeholders. We are committed to ensuring that appropriate
measures and safeguards are in place to protect specific information that is
held for the purpose of the program. We adhere to all legislative requirements
with respect to privacy. We do not rent, sell or trade mailing lists.
Regulations
Accountability
- We will ensure the safe custody and control of all private
information.
- Information will not be transferred to
third parties without the consent
(express or implied) of the individual.
- The Board of Directors will
designate an individual to be responsible for ensuring
privacy and compliance with
the Personal Information Protection and Electronic
Documents Act and all other
privacy legislation. This person will also be responsible
to implement procedures and
train all employees and volunteers.
Identifying Purpose
We understand that some of the information we hold
on members, clients, volunteers, staff, donors, sponsors
and stakeholders is private, which
is why we collect
personal information only for the following purposes:
- To establish and
maintain a responsible relationship and provide ongoing
service and support.
- To conduct appropriate screening
procedures for those volunteers and
staff
who may find themselves in a position of trust with the clients of
the organization.
- To develop, enhance, market or provide
opportunities consistent with
the program mandate.
- To maintain, manage and
develop our programs and operations,
through statistical review, solicited feedback and support.
- To meet
program and government requirements.
Consent
Members, clients, volunteers, staff, donors, sponsors and
stakeholders do have choices and can refuse or withdraw consent for
us to keep and use information.
They may request that their names be removed from our various lists;
they can refuse to provide personal information to us,
and they may withdraw consent
at any time. In all cases this may limit <agency name>'s ability
to provide appropriate service and support to these
individuals.
Limiting Collection
The collection of personal information
shall be limited to that which
is
necessary for the purposes identified by the organization.
Information shall be collected
by fair and lawful means.
Limiting Use, Disclosure and Retention
Personal information shall not
be used or disclosed for purposes other than those for
which it was collected, except with
the consent of the individual or as required
by law. Personal information must be retained only as long as necessary
for the fulfillment of those purposes.
Accuracy
At all times we strive to keep personal information accurate
and up-to-date for the purposes identified above.
Safeguard
Personal information shall be protected by security safeguards
appropriate to the sensitivity of the information. Access
to information will be on a "need
to know" basis only.
Openness
We will make readily available to interested parties specific
information about our policies and practices relating to
the management of
personal information.
Individual Access
Upon request, an individual shall be informed of the
existence, use and disclosure of his or her personal information
and shall be given
access
to that information.
An individual shall be able to challenge the accuracy and completeness
of the
information and have it amended as appropriate.
Challenging
Compliance
We will investigate all privacy complaints
and respond appropriately.
Complaint procedures will be
kept in place and available to all members, clients,
volunteers, staff, donors, sponsors and stakeholders. PREVIOUS PAGE
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