Information relating to special personal circumstances 
Consent to data processing 

Please use this form if you wish to submit or have already submitted to the DFG information on such matters as general health, maternity leave, pregnancy, long-term or chronic illness, disability or a case of hardship – so-called “special categories of personal data”. 

Please only share information that you feel is relevant and please do not mention information about third parties, or as little as possible. 

For details, see www.dfg.de/faq_personal_circumstances

Name:	[in block letters]	
Reference number:	[of the project to which your request relates, if available or applicable]	

Information on my special personal circumstances:

[free text, please overwrite]

Or if applicable, please tick and complete:
[  ] I have already submitted the information on my special personal circumstances to the DFG (in an e-mail or in other documents). 

Details of the correspondence and/or document: [e.g. date, person(s) addressed, file name]

Consent to the processing of my voluntary information including “special categories of personal data”
For the processing and, if applicable, forwarding of such data, you are required to declare consent A below and, where applicable, also consent B, by ticking the respective checkbox. Please tick as appropriate:

A) Consent to internal data processing by the DFG Head Office

In this case, there is no forwarding to reviewers or committee members. 
If you tick A only, please name the document: 73_01_confidential_<last name of person concerned>.

[  ] I expressly consent to the processing of the voluntarily provided data, including “special categories of personal data” for the purpose of an internal check by the DFG Head Office. I may revoke my consent in whole or in part at any time – with effect for the future, freely and without giving reasons – vis-à-vis the DFG (postmaster@dfg.de). The lawfulness of the processing carried out up to that point remains unaffected. Insofar as I transmit “special categories of personal data” relating to third parties in this document, I confirm that the necessary legitimation under data protection law exists (e.g. based on consent). 

B) Additional consent to forwarding to external reviewers and committee members involved in the decision-making process on behalf of the DFG and, in international procedures, also to foreign partner organisations

In this case, in addition to being processed internally by the DFG Head Office, your data will be forwarded for consideration as part of the review and assessment of your project or research activity. If you tick both A and B, please name the document: 73_01_<last name of person concerned>.

[  ] I expressly consent to the processing of the voluntarily provided data, including “special categories of personal data” for the purpose of review and decision-making by the DFG and, where applicable, by foreign partner organisations. This also includes forwarding my data to the external reviewers, committee members and, where applicable, foreign partner organisations who are involved in the decision-making process. To the extent that these recipients are located in a third country (outside the European Economic Area), I additionally consent to them being granted access to my data for the above-mentioned purposes, even though a level of data protection comparable to EU law may not be guaranteed. For this reason, compliance with the data protection principles of EU law is not guaranteed in such cases. In this respect, there may be a violation of my fundamental rights and freedoms and resulting damages. This may make it more difficult for me to assert my rights under the General Data Protection Regulation (e.g. information, rectification, erasure, compensation) and, if necessary, to enforce these rights with the help of authorities or in court.

I have taken note of the DFG’s Data Protection Notice relating to research funding, which I can access at www.dfg.de/privacy_policy and I will forward it to such persons whose data the DFG processes as a result of being mentioned here.

Place, date:		
Signature 

	[if you submit this form via elan or from a personalised e-mail address, no signature is required]