Albion CSD Potential Unauthorized Disclosure of Personally Identifiable Information (PII) Incident Report

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Parents, eligible students (students who are at least 18 years of age or attending a postsecondary institution at any age), principals, teachers, and employees of an educational agency may file a complaint about a possible breach or improper disclosure of student data and protected teacher or principal data. The information that is collected below will be sent directly to the district Data Protection Officer.

Email *

Full name (first and last): *

Telephone number: *

Is your concern related to a data breach, an unauthorized disclosure of data, inaccurate data or a combination? (see definitions below, check all that apply). *

Breach--Unauthorized acquisition, access, use, or disclosure of protected data by or to person not authorized to acquire, access, use or receive it.

Unauthorized Disclosure--Any disclosure or release of protected data that is not permitted by applicable laws or agreements or not responsive to a lawful order

Incorrect/inaccurate data--Student, teacher or principal data is inaccurate, incorrect or missing

Required

What is your role or relationship to the individual(s) whose data you feel may have been breached or improperly disclosed? *

Which school building is the individual in? (Check all that apply) *

Elementary School

Middle School

High School

Other:

Required

Briefly describe the breach, unauthorized disclosure, or inaccurate information. *

Briefly describe how you learned of the potential breach, unauthorized access, or inaccurate data. *

A copy of your responses will be emailed to the address you provided.

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