Data Request Form

Please provide as much information as possible so that we can respond to your needs.

*Required Fields

REQUESTER INFORMATION

*Name:

Name is required

Institution/Organization:

Internal GCCCOther  

Title:

Department:

Are you:

FacultyStaffStudentOther  

*Phone Number:

Phone Number is Required

Fax Number:

E-Mail Address:

E-mail Address is Required Please enter a valid e-mail address.
REPORT INFORMATION

Request Needed by?:

Reason for Request:

External UseGrant UseInternal Use

How will you be using these data? (Please provide as much detail as possible)

Description of data needed: (Please provide as much detail as possible)
Example of what NOT to ask for: How many student are at GCCC?
Example of what to ask for: How many full time, degree-seeking, first-time student were enrolled at GCCC during the Fall 2008 term on the Panama City Campus.

For what period are you requesting: (i.e. current semester, Fall 2008, current academic year)

How would you like the data sorted/displayed? (i.e. by gender, ethnicity, department)

How would you like the requested information sent to you? EmailInteroffice MailFaxPhone
Will this be a recurring request?: YesNo

Confidential information is provide in response to specific request. Disclosure of this information to unauthorized parties violates the Family Educational Rights & Privacy Act (FERPA).

It is expected that you will:

• Handle this information in a confidential manner, keeping it secure at all times.
• Communicate this information ONLY to other parties authorized to have access to it in accordance with the provisions of FERPA.
• Use this information only for its intended purpose.
• Properly dispose of this information when it is no longer needed.