Date Needed By: (mm/dd/yy)   

Please note that if a request requires access of system data and analysis, the processing time could vary.  A representative from our office will contact you within 48 hours of the initial request.                        

Request:

(Be specific)

(How will results be used/applied?)

**If you are requesting sensitive information for a research project or other external purposes you must receive and submit an Institutional Review Board (IRB) approval letter before your request can be processed.  To learn more about IRB please visit http://www.deltastate.edu/pages/2515.asp.**