EU GDPR Withdrawal of Consent Form

I hereby withdraw my consent pursuant to the EU GDPR and The College of Saint Rose’s Notice to
Individuals Located in the European Union and request that the College remove all of my personal data
that does not need to be retained in accordance with another applicable laws and/or regulations.

I understand that if I do not give consent, then the College may not be able to provide services to me
while I am present in European Union states.

*

Please Withdraw My Consent

First Name *

Last Name *

Email

Resident Country *

Birth Date - (MM/DD/YYYY) *

Birth Location *

Electronic Signature *

Please type your first and last name

Date - (MM/DD/YYYY) *