Data Request Form

Name

First Name

Last Name

Phone Number:

(###)

###

####

Affiliation:

For example, the name of your community, school, business, organization, volunteer community group, government, department, etc.

Project Summary:

This can be a research abstract, for example, or guided by the following questions: What’s the purpose of your research? What data are you interested in? What questions are you trying to answer? How will you share results?

Partners and team members:

If you're working on this with a group of people, you can name them here.

Outputs and Outcomes:

What will be created as a result of this further analysis (e.g., reports, social media graphics, art, and more)? What will be made possible as a result of this analysis (e.g., greater understanding, decision-making, policies, programs)?

Data Request Form

1525 Birmingham Street, Halifax, NS, Canada, B3J 0B5