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24 марта, вторник 12:36
 
Сonsent to personal date processing courses
01.02.2022 г.


CONSENT

to personal data processing

City of Tver                                                                                      «___»___________2022

I__________________________________________________________________

                                (surname, first name, patronymic name)

registered at the following place of residence:______________________________

_____________________________________, national identity document type________________,series_____________,Number_____________________, the authority that issued the document __________________________________________________________________,

the date of the document issue________________ hereinafter referred to as a Subject, in accordance with Federal law "On personal data" as of July, 27th 2006, No 152-FZ hereby grant my written consent voluntary, by my own free will and in my own interest, on processing my personal data (hereinafter referred to as Contest) to the Federal State-Funded Educational Institution of High Education “Tver State Medical University” of the Ministry of Health of Russia (FSBEI HE Tver SMU of the Ministry of Health) address: 170100, Tver, Sovetskaya st, 4 (hereinafter referred to as University).

Authorized officials of the University are given consent to processing following actions (operations) or the set of actions (operations) regarding the personal data processing with use of automated means or without such means: collection, recording, ordering, accumulation, storage, adjustment (updating or modifying), retrieval, utilization, transfer (dissemination, provision, access), de-personalization, blocking, removal, erasure of following personal data:

- surname, first name, patronymic, gender, citizenship, date of birth, place of birth;

- education, qualifications and their level;

- information about academic performance, including the results of the final state certification, for educational programs in which the Subject participates in the in the admission company of the University;

- information about academic performance, including the results of the final state certification, for educational programs mastered by the Subject while receiving education at the University, including courses and final control (final-qualification, scientific-qualification) works and their assessments;

- registration address, residence address, postal address;

- phone numbers (mobile, home, work);

- email address;

- name and details (series, number, name of the issuing authority (organization), date of issue, registration number in the presence of identity documents, documents on education and/or qualifications;

- information about the existence of special rights when applying for training and about the grounds for the occurrence of the corresponding rights;

- information about the state of health, including disability and disability;

- information about the work of military duty (if any);

- personal photos; biometric data, video recordings;

- place and address of work, position;

- information about the concluded agreement (education agreement, if enrollment for training is carried out under education agreements at the expense of individuals and (or) legal entities; target admission agreement; target training agreement);

- INN and SNILS;

- information about marital status, next of kin (parents, children, spouses);

- information about participation in competitions and other events held by the University and (or) third parties, and about the results of such participation, including research work performed (performing) by the Subject;

- information about hobbies, including sports, participation in events related to cultural, social, volunteer activity of the Subject, and the results of such participation;

- personal data of the legal representatives of the Subject;

- other information provided to the University in connection with participation in the admission company.

The Subject provides this consent to the processing of personal data in order to ensure that the University complies with the requirements of current legislation, including the Federal law "On Education in the Russian Federation" as of 29.12.2012 No 273-FZ (as amended on 30.04.2021), the Federal law “On the Fundamentals of the Health of Citizens of the Russian Federation” as of 21.11.2011 No 323-FZ (as amended on 26.05.2021), the Federal law "On personal data" as of 27.07.2006, No 152-FZ (as amended on 30.12.2020), the Federal law " On mobilization training and mobilization in the Russian Federation" as of 27.07.2006, No 31-FZ (as amended on 23.12.2003), Tax Code of the Russian Federation, to carry out the statutory activities of the University provided for by the University Charter approved by the order of the Ministry of Health of the Russia as of 23.06.2016 No 391, to carry out the statutory activities of the university provided for by the University Charter approved by the order of the Ministry of Health of the Russian Federation dated 27.01., as well as to ensure the possibility of the participation of the Subject in the admission campaign of the University; transfer of information to federal information systems, including the system of admission of citizens to educational organizations of secondary professional and higher education, for posting on the official website of the University information about persons who submitted documents required for admission to the University, indicating data on the participation of persons in the entrance tests and the results of such tests, placement of orders for enrollment: transfer of information about the Subject to other organizations in cases of conclusion of contracts for the provision of paid educational services and (or) targeted training; registration of bank cards for receiving scholarships; confirmation of the fact of studying at the University; check-in and accommodation in dormitories; organization of sports and recreation, cultural events; assistance in obtaining social support measures and employment; organization of military, migration and statistical accounting and reporting; other cases provided for by current regulatory legal acts.

I confirm the authenticity of the documents provided and the accuracy of the information.

This consent is valid from the moment of submission by the Subject and during the period of admission, training and subsequent storage in the archive of the University in accordance with the requirements of current legislation.

I am aware that Consent to the processing of personal data can be withdrawn by the Subject in writing, in accordance with the procedure established by the Federal law "On personal data" as of 27.07.2006, No 152-FZ (as amended on 30.12.2020). At the same time, I am warned that in case of withdrawal of Consent of the personal data processing, the University has the right to continue processing data without my consent if there are grounds provided for sub-paragraphs 2-11 of paragraph 1 of article 6 and paragraph 2 of article 10 of the Federal law "On personal data" as of 27.07.2006, No 152-FZ (as amended on 30.12.2020).

 

 

Signature of the Subject___________________

 

Surname, Name, Patronymic name_______________________________________

 

Agreed


(filled in if consent is given to minors aged 14 to 18 years)

 


(Surname, Name, Patronymic name of the representative of the subject)


 


                                                        (address of the representative of the subject)

National identity document type________________, Series_____________, Number_____________________, the authority that issued the document __________________________________________________________________,

the date of the document issue__________________________________________

 

«___»___________2022

__________________________________________________________________

(Signature/ Surname, Name, Patronymic name of the representative of the Subject)

 







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