Information Request


Name*

Email*

Department*

Phone*

Name of Report*

Date data needs to be completed*


Please be specific about the data that needs to be in the report(s). Please include the term(s)/year(s) needed.

List Reports
How will this data be used?
Comments

If you are submitting an Excel spreadsheet for Clearinghouse information, please use the following format.
  • Social Security Number (no dashes)
  • First Name (no nicknames)
  • Middle Initial (No periods after initial)
  • Last Name (no suffix added)
  • Name Suffix (No periods after letter - ex. Jr, Sr. III)
  • Date of Birth (YYYYMMDD)
  • Search date You would like for me to use (YYYYMMDD)



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