1. Name:

2. Department:

3. Phone Number:

4. Email Address:

5. Need-by date (MM/DD/YYYY):
(Note: If less than 3 business days, please contact us directly.)

6. Description of Request (Please provide as much detail as possible including definitions and specific years/semesters. Any supporting documents can be emailed to Institutional.Research@armstrong.edu.):

7. How will this data be used?

8. Will this be a recurring request? If yes, please specify the frequency.