Essential Skills for Success Assessment (ESSA) – Consent Form

Collection and Use of Information

I hereby consent to allow the New Brunswick Department of Post-Secondary Education, Training and Labour (PETL) and its agents to collect and use my personal contact information so they can assign me access to the Virtual Learning Strategy (VLS) program’s Essential Skills for Success Assessment (ESSA). My name and email will be used by VLS to create my account on the VLS online portal. I will complete the ESSA within two weeks once it is assigned to me and I agree to be contacted by the program once I complete it.

Authority for the Collection of Information 

The information you provide will be collected and used as set out in the “Right to Information and Protection of Privacy Act”. The information collected by PETL relates directly to, and is necessary for, VLS program services. The collection and usage of this information is authorized under Paragraph 37(2)(a) and 44(a)(e) of the Act. The information collected will be saved for seven years and disposed of, following PETL’s Document and Record Management Policy.

You may revoke this consent at any time; however, doing so will affect your eligibility to complete the assessment. If you have any questions about the collection, use, and disclosure of information collected on this form or if you want to make any corrections to your personal information in the future, you may contact: Program Integration Manager, Virtual Learning Strategy Program, 470 York St., Fredericton NB, E3B 3P7, email: vls@gnb.ca | phone: (506) 453-8641

Disclosure of Information

VLS will be required to disclose your contact information and/or assessment results to the following:

  • NL’s ATCD for the purpose of communicating your eligibility for referral to the VLS program;
  • researchers connected to the VLS program to evaluate support services; and
  • VLS online portal developers / IT support to set up and access the online assessment.

The information collected will be disclosed to the various stakeholders above as per ss 46(1)(a.1) of the Act.

By signing this consent, I acknowledge that I have read the above and consent to complete the VLS program’s Essential Skills for Success Assessment. I further acknowledge that I can revoke my consent in writing at any time and, in doing so I understand that I will no longer be able to participate in this service because of the requirements established by the VLS program.

Full Name(Required)
Date(Required)
To sign your name, use your finger, mouse or other compatible input device inside the dotted box. To start signing, press or click, hold and move. To stop signing, lift or release. To clear the signature, press or click the arrows icon in the bottom right corner.
Parent/Guardian Name (for clients under 19 years of age)
To sign your name, use your finger, mouse or other compatible input device inside the dotted box. To start signing, press or click, hold and move. To stop signing, lift or release. To clear the signature, press or click the arrows icon in the bottom right corner.

FORM SUBMISSION INSTRUCTIONS:

  • Upon submitting this form, you will receive a message that we have received your form. No need to email us for further confirmation at this point.
  • The form will be processed in the next 10 working days, and you will receive an email with further instructions and a link to the ESSA quiz.
Privacy statement(Required)