Co-operative Education
CONFIDENTIALITY
STATEMENT
Co-operative Education Confidentiality Statement
I,
the undersigned, promise to hold in
confidence all matters that come to my attention as a Co-operative Education student at:
(Name of Co-operative Education Placement)
This includes material from and about clients, matters regarding colleagues, and other
confidential information regarding the organization. I will respect the privacy of the people whom I
serve and confer appropriately with my supervisor(s) about confidentiality matters. I will use in a
responsible manner any information gained in the course of my Co-operative Education
placement.
During the pre-placement component of the Co-operative Education program, students receive
instruction regarding the importance of confidentiality in the workplace. Any breach of
confidentiality may result in the removal of the student from the work placement and/or Cooperative Education program. The Waterloo Region District School Board assumes no legal
responsibility for breach of confidentiality on the part of the student.
Name of Student: (print)
Student Signature:
Date:
Parent Signature:
Date:
Name of Workplace Supervisor: (print)
Workplace Supervisor
Signature:
Date:
Name of Co-operative Education Teacher: (print)
School:
Co-op Form #23 (04/11) PLACEMENT
Copies to:
Teacher
Placement Supervisor
Student/Parent