External Research Request Intake

Question Title

* 1. Enter your contact information

Name *

Company *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number *

Question Title

* 2. Enter your job title

Question Title

* 3. Provide a summary of your research request, including the information/data you need and your purpose for this information.

Question Title

* 4. Please attach any files we need to answer this request.

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.

Question Title

* 5. In what format do you prefer the response?

Spreadsheet/tables

Graphs

Written summary

Other (please specify)

Question Title

* 6. When do you need this request completed? Due date should be two weeks or later than the date this form is submitted.

Date / Time

Date

Question Title

* 7. If you need this request sooner than two weeks, please explain why:

Question Title

* 8. Is the data/information you are requesting to be used in a project that you are working on with DED staff?

Yes

No