FIU: Analysis and Information Management
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Data Request Form
Please complete this form with as much information as possible. (*Required Fields)

Name*: Title*:
Department/Office*: Status:
Phone*: Fax:
Request (e.g., Student headcount by ethnicity, Fall 2010)*
How will the requested data be used?
What/who will be the intended audience for this data?
Data Format*: Other Format:
Completion Date*:
/ /
Please allow 10 working days for your request to be processed.
   Analysis and Information Management
   Modesto A. Maidique Campus, PC 543 | (305) 348-2731 | Fax (305) 348-1008 |