Privacy Breach Form

A privacy breach is the result of unauthorized access to, or collection, use, or disclosure of personal information. Such activity is unauthorized if it occurs in contravention to the Freedom of Information and Protection of Privacy (FOIP) Act.  Some of the most common privacy breaches happen when personal information is stolen, lost, or mistakenly disclosed.

If you have discovered or are aware of a privacy breach, please fill out this form. You may also complete

and notify the Privacy Office Coordinator (403-332-4620 ), so the breach can be contained and the risk can be assessed.
Contact Information
Nature/Scope of Personal Information Involved

All information collected on this form is maintained by the University of Lethbridge Privacy Office to help respond to the breach.

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. It will be used for the purpose of investigating and responding to a report of the privacy breach contained herein.  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, email: