Form Request

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Records & Information Management Red Deer College 100 College Blvd Box 5005 Red Deer, Alberta CANADA T4N 5H5 Telephone: 403.342.3588 Fax: 403.340.8940 Web-site: www.rdc.ab.ca/rim FORM REQUEST The information on this form will be used by Records and Information Management in order to process your Form Request. The information will be protected in compliance with the provisions of the Freedom of Information and Protection of Privacy Act of Alberta. RIM USE ONLY TRACKING # ORIGINATOR INFORMATION NAME DEPARTMENT / PROGRAM AREA PHONE NUMBER EMAIL ADDRESS FORM DETAILS Does the form currently exist on the RDC Info Index and/or the RIM website? OWNER OF FORM (Department / Program Area) DEPARTMENT/PROGRAM AREA PHONE NUMBER SUGGESTED TITLE OF FORM (Subject to Change) NO NEW FORM CONTACT PERSON YES FORM REVISION DEPT/PROGRAM AREA WEBSITE ADDRESS SUGGESTED SUBTITLE (If Applicable) FOIPP STATEMENT PURPOSE(S) FOR COLLECTION (Include all purposes for collection and uses of information.) GOVERNING BODIES OR STATUTES RELATING TO INFORMATION COLLECTION WILL THE INFORMATION BE SHARED WITH ANYONE? NO YES WHO? DEPARTMENT/PROGRAM LEADERSHIP REPRESENTATIVE TITLE RETENTION PERIOD (Minimum One Year) PHONE NUMBER STEPS IN THE FORM PROCESS: 1. Form Request Submission 2. Form Analysis & Design 3. Form Originator Review 4. From Review/Revision 5. Form Originator Approval 6. FOIPP Approval 7. Form Completion   TIMELINES MAY INCREASE FOR EACH FORM ALREADY IN THE QUEUE FORMS WILL BE PLACED IN THE QUEUE IN THE ORDER THEY ARE SUBMITTED EXPECTED TIMELINE: Minimum 6 Weeks TIMELINES MAY BE ADJUSTED BASED ON PRIORITY AND/OR THE FOLLOWING CRITERIA: Is the Form collecting Personal and/or Health Information? Is the Form to be completed by or directed to an external source? (Student, Community Member, etc.) Is the Form to be completed by or directed to an employee of the College? Is the Form conducting a Survey or Questionnaire? (Research Ethics Committee Involvement) Is the Form required for a Certain Event? Date of Event? Is this a revision of an existing form? (The form is currently on the RDC Info Index / RIM Website) Is this a new form? (The form is not currently on the RDC Info Index / RIM Website) Have you created the form using the Form Design Template provided? Have you included a completed FOIPP Statement using the sample statements provided? 02/09

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