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Data Request Form

*Last Name:
*First Name:
*Department:
Title:
*ULV Email Address:
Phone/Extension:
*Date of Request:
*Requested Completion Date:
*Title of Report:
*Priority: High Medium Low
State the purpose of your request:
*Describe the report parameters including population selection criteria:
*What information do you need on the report/output:
*Report Format: PDF
Excel
Paper Report
CSV
Other
    If Other Please Specify:
* = Required, do not leave blank.