Data Analysis Information Request Form

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Data Analysis/Information Request Form
Note: Please read the complete directions on page 2 prior to completing and submitting this form. When
completed please send to IR&A at Box 11851.
Date Request Submitted: ____________________
Name and Title of Person Making Request: ______________________________________________
Check one:  Faculty
 Staff
 Off-Campus
Department/Office: _________________________________________________________________
Email: __________________
Phone: ___________
Fax: ___________
SLU Box: _________
Information/Data Analysis Requested:
How will data analysis/information being requested be used?
Required Signatures (as appropriate):
---------------------------------
---------------------------------
Person Making Request
Immediate Supervisor
---------------------------------
---------------------------------
Additional Signature
Additional Signature
For Office Use Only
Name of Project/Report: __________________________________________
Date Request Received: _____________________
Type of Request:  Internal
 State
 Federal
 Other External
 Institutional Effectiveness
Staff Members Assigned: ____________________
Negotiated Deadline Date: ________________
Date Completed: ___________________
Number of Staff Hours: _____________

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