Data Request Form

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

*Required Fields

REQUESTER INFORMATION
*Name:
Institution/Organization:	Internal GCCC Other
Title:
Department:
Are you:	Faculty Staff Student Other
*Phone Number:
Fax Number:
E-Mail Address:
REPORT INFORMATION
Request Needed by?:
Reason for Request:	External Use Grant Use Internal 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? Email Interoffice Mail Fax Phone
Will this be a recurring request?: Yes No

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

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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.