Attachment 1 - Information Request

Information Criteria
Information Requsted
Output Format
Purpose for Request
Deadline
Privacy Policy Reminder
Upon submission you agree that the unified database information provided shall be used solely for the purpose(s) described above and that you will maintain the confidentiality and privacy of that information in compliance with all of the requirements of the Confidentiality and Non-Disclosure Agreement to which you agreed and is on file with your super user. You agree that upon completion of the use for which this request is made, you shall use reasonable efforts to return all hard copies and to delete and destroy to a non-readable form any and all other copies in any other form of the unified database information that were supplied to you pursuant to this request.