Report a Privacy Breach – SelfDesign Support Request

Name *

First

Last

Email *

Phone

Role *

Submission Details

Please give as much detail as possible. Please do not provide actual personal information, only types of personal information such as “Parent A’s personal email address” or “Student’s name”. Thank you for reporting. Your commitment to privacy is appreciated.

Describe Incident *

Date Incident Discovered *

Number of Individuals Affected *

Types of Individuals Involved *

Select all that apply

Describe the Types of Personal Information Involved *