Security Incident Form

All security reports are held in the strictness of confidence Name (required): Description of Incident (required):

Additional Information

Date of Incident: Campus: Grande Prairie   Fairview Email Address: Phone Number: Emergency Contact Number: Staff / Student ID: RCMP File No: I Am a: Student   Staff Estimated Value of Any Lost/Stolen Goods:

By submitting this form, you are giving us permission to contact you as needed. The personal information you provide on this form is collected under the authority of the Post-secondary Learning Act and in compliance with section 33(c) of the Alberta Freedom of Information and Protection of Privacy (FOIP) Act and will only be used for the purpose of recruitment, research, and processing of your request by our institution. In pressing Submit below, you consent to this use of your personal information. Questions about the collection or use of this information should be directed to the Office of the VP Finance and Administration, 780-539-2068.