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Form Submission
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Full Name:  
Job Title:  
Email:  
Supervisor:  
Phone:  
Campus/Location:  
Program Area:  
Will this data be shared outside of OC?:     If yes, with whom:
Will this be a recurring request?:     If yes, how often:
Is this an update of a previous data request?     If so, please describe the previous request or provide a link to the location :

Please state your desired outcome, or the research question(s) you intend to answer with this data, or state the specific data request (e.g. if the request is for an external agency or mandate).


How will the data be used? A detailed explanation of the specific purpose for the data may help us determine the most appropriate data set to provide and ensure the appropriate redactions are applied. Please also list all groups or persons who will be working with this data.


What criteria would you like to include in your report?

If requesting student data, are you requesting (select all that apply):


Other student data:


Quarter/year of data desired. Range of years/quarters? Please specify:


Date required (minimum 15 working days):


NOTICE: The information contained in any report of student information may contain personally identifiable information that is legally protected by the Family Educational Rights and Privacy Act of 1974 (FERPA). All College employees who access this information must make every effort to store student data in secure and confidential environment. Only administrators, faculty and staff employed by Olympic College who demonstrate a genuine need to know based on a legitimate educational interest may have access to student records. A legitimate educational interest will be limited to an interest arising from the faculty/staff member’s fulfillment of his/her assigned responsibilities, and disclosure will be limited to such information that is necessary to fulfill those responsibilities. The contents of any report must not be shared with anyone who does not have a legitimate, demonstrated need to know the information contained therein. Official student, program, college, department, faculty, and staff statistics should only be obtained and released with guidance from the Office of Institutional Effectiveness (IE). Once you have completed use of this information for the purpose described above, it should be destroyed, including all electronic and paper records. Original records will be held by IE in accordance with state and federal records retention requirements and duplicate reports should not be held by individuals or departments once use of the report is completed.
Your supervisor may be contacted to authorize this request.

I understand and accept the conditions described above