Targeted Email or Population Request

1 Current Customer Information
2 Target Population Details
3 Complete

Targeted request: Customer information

Provide the information for the person we should contact in case we have questions about this request.

Contact name

Preferred phone number

Department

Request information

I am requesting a:

Targeted email

Data file

What is the reason for this request?

Provide a brief explanation (no more than 2500 characters) for the request. For example, to communicate how a project will affect campus stakeholders next month or to communicate a change in policy that requires a change in behavior.