Protection of Privacy – The personal information requested on this form is collected under the authority of Section 33(c) of the
Alberta Freedom of Information & Protection of Privacy Act and may be disclosed under section 40 of the
Alberta Freedom of Information & Protection of Privacy Act. It will be used only for the purpose of registration and administration outlined in the above session description offered by the University of Alberta Counselling and Clinical Services (CCS). Direct any questions about this collection to the Assistant Dean of Students, Health & Wellness at 780.492.4145.