Residential School - if you attended or have a family member who did, you can request your school records. The form and address are enclosed below.

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INFORMAL REQUEST FOR PERSONAL INFORMATION

If you wish information on your attendance at a residential school, please fill in the information indicated below. This information is required to ensure identification of the correct student within the records.

Please Print Clearly.

Full name of the student: ________________________________________

Date of birth: __________________________________________________

Any names by which the student might have been known at the time he/she attended the school: ____________________________________________

Names of the parents or guardian:       Mother         ______­­­­­­­­­___­­­________________

                                                          Father                   _________________________

                                                          Guardian      _________________________

Band affiliation: ___________________________________________________

Treaty or Band Number at the time in school: __________________________

Name of school(s) and approximate years attended each school:

_______________________________________19______to 19_______

_______________________________________19______to 19_______

_______________________________________19______to 19_______

_______________________________________19______to 19_______

Print Complete Home address:   ____________________________________

                                                ____________________________________

                                                ____________________________________

                                                ____________________________________

Telephone number: (_____) _______________________

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A search will be made for any information regarding your attendance at the above-mentioned residential school(s).

Signature ______________________                 Date ____________________

                     Former Student

Mail your request to:

Access to Information and Privacy Section

Library and Archives Canada

Room 349, 395 Wellington Street

Ottawa, Ontario

K1A 0N4

NOTE: If you would prefer that we send this information to someone else (for example, your lawyer) rather than sending it to you, please sign below and provide the name and address.

I wish the records retrieved in response to this request to be sent to:

Please Print Clearly.

Name of Lawyer:    __________________________________

Address:       ____________________________________

                   ____________________________________

                   ____________________________________

                   ____________________________________

Telephone number:          (_____) _______________________

NOTE: To obtain information on someone else you must provide us with their signature giving you their consent or if they are deceased we require a proof of death as well as proof of relationship.

The information you provide on this form, collected to provide you with information from Federal Government Records, is described in Library and Archives Canada Personal Information Bank LAC PSU 901(Access to Information and Privacy Requests). It will be retained for two years and then destroyed. Its use is restricted to authorized Library and Archives Canada personnel to respond to your request and to compile statistics regarding use of Access to Information, Privacy and Personnel Records Division’s services.