FOIP Statement 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 and Protection of Privacy Act (“Act”) and will be protected under Part 2 of the Act. The information is collected for the purpose of identifying practicum and internship placements for students. If you have any inquiries in regards to the collection of your personal information, please direct those inquiries to: FOIP Coordinator, University of Lethbridge, 4401 University Dr. West, Lethbridge, Alberta T1K 3M4, telephone: 403-332-4620. Demographics First Name: * Surname: * School Name: * Options Available: * Please Select:CashDonation to School FundTuition Voucher (For Education courses only) Cash Option U of L ID (if known): Birthdate (Day/Month/Year) * MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Year Social Insurance Number: * Home Address: * City: * Province: * Postal Code: * Tuition Option U of L ID (if known): Birthdate (Day/Month/Year) * MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Year Social Insurance Number: * Home Address: * City: * Province: * Postal Code: * Leave this field blank Submit