External Research Request Intake Question Title * 1. Enter your contact information Name * Company * Address * Address 2 City/Town * State/Province * -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code * Email Address * Phone Number * OK Question Title * 2. Enter your job title OK Question Title * 3. Provide a summary of your research request, including the information/data you need and your purpose for this information. OK Question Title * 4. Please attach any files we need to answer this request. DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only. Choose File Choose File No file chosen Remove File Please attach any files we need to answer this request. OK Question Title * 5. In what format do you prefer the response? Spreadsheet/tables Graphs Written summary Other (please specify) OK 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 OK Question Title * 7. If you need this request sooner than two weeks, please explain why: OK 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 OK NEXT
