Name*: Title*: Department/Office*: Status: Choose one Administrator Faculty Staff Other
Phone*: Fax: E-mail*:
Request (e.g., Student headcount by ethnicity, Fall 2008)*
How will the requested data be used?
What/who will be the intended audience for this data?
When do you need the data?* Jan Feb Mar Apr May June July Aug Sep Oct Nov Dec 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2009
In what format do you wish to have the data? Choose a format ASCII HTML Excel Word Other Other format:
Please allow 10 working days for your request to be processed.