Data Request Form

Name *

Phone *

Status *Undergraduate Student
Graduate Student
Staff
Faculty
Non-DePaul

Request Date *

Email *

Department *

School *

Area of Study *

Funding Source *

Date Needed by *

Desired Format of Data *

Research Overview: (Please describe the purpose, aims, objectives and intended dissemination of your research, Limit: 500 Characters) *

Please describe how this data will be used: (preliminary investigation, support of funding proposal, testing a specific hypothesis. Limit: 500 Characters)

I would like to schedule a meeting to discuss additional information *Yes
No
N/A

I have obtained IRB Approval to use the data *Yes
No
N/A

These data will be used for research purposes and will be cited appropriately *Yes
No
N/A

This data will be used to support a program, intervention, policy or practical purpose *Yes
No
N/A

I understand that my receipt and use of these data will be subject to a written approval of FSSC director *Yes
No
N/A

Policies & Forms

Smart Form Standard Web Part 2

Requester Information

Request Information

Please check Yes, No or Not Applicable (N/A)*