REGISTRAR’S OFFICE
REQUEST FOR DATA
Dept. or Organization _______________________ Phone # _______________________________
Contact Person ____________________________ Email __________________________________
Data to be selected: (What requirements to be met?) ________________________________________
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_____________________________________________________________________________________
Description of report: (How do you want it to look?)__________________________________________
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Date needed:____/____/_____
Note: Allow 3 business days for processing. If first-time request or data is needed during extremely busy
times, allow at least 5 business days for processing.
Please complete this section where applicable.
____Full Time ____Part Time ____All Students Number of Copies_______
Address: ____Home _____Local Year Semester ______
All lists will be in alpha order unless otherwise specified.
Sort by: _____________________________________________ (I.D. #, Dept., Class., GPA., etc.)
Reason data needed: ___________________________________________________________________
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“I certify that the requested data will be used by the undersigned for the sole purpose as stated in this
form and that use of this data for any other purpose constitutes a serious violation of College policy.”
______________ _______________________________________
Date Signature of Faculty Advisor, Administrative Officer
or Department Head
For Registrar’s Use Only
Date & Time Rec’d___________________
Date Completed ____________________
Completed By ______________________
File Used __________________________