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Administrator/Faculty Signature
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Email Address
______________________________
Telephone Number
• Handle the information in a secure fashion to endure it remains confidential
• Communicate the information only to other parties authorized to have access to it in accordance with the provisions of FERPA
• Use the information only for its intended purpose
• Properly dispose of the information when it is no longer needed
Request for Institutional Data
2. To help us respond, please tell us what type of data you are requesting:
3. Date Needed: _________________ Other:
We strive to complete all requests within 10 business days (depending on the complexity and priority status of the request.)
4. Describe output desired. What data is needed, what are the selection criteria; in what sequence should data appear, and how should data be
separated. (For example, supply a list of transfer students majoring in journalism along with their permanent address and emails for Spring Term
2020, in alpha order.)
The data system provides several choices for address, and major/minor, etc. Please be specific. If necessary, type in a sample of the desired
output.
5. Use and Purpose of Data: How will the information be used?
6. Is this data going to be used for a survey? _____ no _____ yes Used for research ? _____ no _____ yes NOTE: All research with human participants
conducted by faculty, staff and students associated with the University of North Dakota, must be reviewed and approved as prescribed by the University’s policies and procedures
governing the use of human subjects. No activities are to be initiated without prior review and approval by the Institutional Review Board. University Analytics & Planning will require
the following: a copy of the consent form from IRB; approval letter and application for IRB.
7. If confidential information is provided, describe procedures you will implement to protect confidentiality.
I have taken FERPA traning. _____ no _____ yes
8. The requesting administrator/faculty must agree to the following:
The requested information will be used for the above purposes only. As the UND administrator/faculty responsible for the organization or office outlined above, I recognize that any
other use of this information violates the Family Educational Rights and Privacy Act (FERPA) and cannot be released further on or off campus.
If provided with confidential information, I will expect to:
Please complete this form and "Submit Request" at the bottom of the form. If the “Submit Request” button does not work,
Please download and complete the form using Adobe Reader. Once completed, please email to matthew.berosik@und.edu.
1. Requester Name: ___________________________
Email: _______________________________ Phone: ___________________
Requester is:Faculty, Staff, Student, Non-UND (please specify) ______________________ UND Division/Department:_____________________
Before submitting your data request, please visit https://und.edu/analytics-and-planning or the internal dashboards available for all UND faculty and staff
to see if the information requested already exists.
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