Information Sheet

Consent Form

This Consent Form is designed to let you know about the potential use of the information arising or
collected from the process of Academic Advising.

Please READ the following information carefully before completing the Consent Form. The BSE
Academic Advisor can also explain this form to you.

Collection of Personal data

1. In the academic advising process, the designated BSE Academic Advisor is given access to or
provided with various types of your personal data. The personal data collected, including both academic
and non-academic issues, are for the purpose of Academic Advising. Besides, BSE will analyze the
related data in an aggregated and anonymous manner so as to understand the adjustment of PolyU
students and to generate publications based on the analysis. Under normal circumstances, student
records kept by BSE will be disposed of within 3 years from your graduation.

Disclosure of Personal Data

2. The BSE Advisor is committed to implement and comply with the Personal Data Privacy
Ordinance (PDPO) and all relevant and applicable policies in PolyU. It is the obligation of BSE
Advisor to protect the privacy and make sure the handling of personal data complies with the
strictest standards of security and confidentiality.

3. Under the requirements of PDPO, your personal data should only be used and disclosed with your
prescribed consent, or for the purpose (or a directly related purpose) for which the data has been
collected (except for the conditions stated in paragraph 4). Besides the BSE Advisor, student who
participates in group advising session/activity with other advisees should also observe these
requirements in order to protect the privacy and confidentiality of other students.

4. Apart from the above, PDPO has provided certain exemptions on such grounds as prevention of
crime, unlawful or seriously improper conduct, and protection of physical or mental health of the
informant. In such exceptional circumstances which involve personal safety of yourself and/or
others, BSE Advisor might disclose or transfer your related information to a third party (such as your
parents, the Counsellor of the Office of Counselling and Wellness (OCW)). However, even if you
have given your consent to disclose, duly care would be exercised in providing only the data
necessary and pertaining to the student(s) concerned only.

Data Access/Correction Requests

5. If a student providing personal data wishes to access/correct the personal data kept by BSE
Advisor, you may do so under the PDPO. Please send written request to the relevant Data
Protection Officer of BSE:

BSE General Office (Room ZS867, 8th Floor, Block Z, PolyU; Tel: 2766 5847)

BSE Form 01A (08/2020)

 Confidential

Consent Form for Disclosure of Information in Academic Advising

I have read the Information Sheet. I fully understand its content and consent to each of the
following items with respect to the Academic Advising in the Hong Kong Polytechnic
University.

1. I understand that the personal data of myself and/or other advisees are collected or
discussed for the purpose of Academic Advising. The data would be kept confidential
and shall only be discussed with/disclosed to individuals who are authorized to have
access to such data. It shall only be used or disclosed, with my prescribed consent, or
for the purpose (or a directly related purpose) for which the data have been
collected.

2. For the present or future benefits of myself and related purpose, or where permitted
by law, I understand and consent that the designated BSE Academic Advisor may
forward the related information to a third party ONLY on a need‐to‐know basis or
under exceptional circumstances involving personal safety of myself and/or others.

3. I confirm that this consent shall remain valid unless and until written notice of my
revocation is received by the designated BSE Academic Advisor.

Signed:

Name: Li Wan Tik

Student ID: 20043922D

Department: Building Services Engineering

Date: 7/9/2020

BSE Form 01A (08/2020)