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Request form

Please fill in the information below. The website administrator or data protection officer will be notified of your request within 24 hours, and will need an appropriate amount of time to respond.





    The person, or the parent / guardian of the person, whose name appears above.An agent authorized by the consumer to make this request on their behalf.



    Confirm that my personal information is being processedAccess my personal informationEdit / correct my personal informationHave my personal information deletedRestrict the processing of my personal informationAsk a question about Supporting Success for Children with Hearing Loss's privacy policyWithdraw my consent to the processing of my personal informationDeny Supporting Success for Children with Hearing Loss the right to use my personal information for purposes of direct marketing, including profilingOther (please specify in the comment box below)


    Know what information is being collected from meHave my information deletedOpt out of having my data sold to third partiesOpt in to the sale of my personal dataOther (please specify in the comment box below)



    Under penalty of perjury, I declare all the above information to be true and accurate.
    I understand that the deletion or restriction of my personal data is irreversible and may result in the termination of services with Supporting Success for Children with Hearing Loss.
    I understand that I will be required to validate my request by email, and I may be contacted in order to complete the request.


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