Data Request Form: STD/HIV/TB Section - Minnesota Dept. of Health

Data and Presentation Request Form: STD/HIV/TB Section

Please note: Requests may not be completed by requested due date if surveillance staff are given less than 2 weeks to complete the analyses.

Staff will be in touch with you to negotiate/confirm a final date for product delivery or presentation and to clarify any questions.

For data or presentations regarding diseases other than STDs, see Diseases and Conditions Statistics.

Data and Presentation Request Form

Requestor First Name



Requestor Last Name



Organization or Affiliation



Phone



E-mail



Type of request (presentation, data, other):



Please specify if other type:



Type of data requested:

data
data
data

Please specify data set type if requesting a data set.

(Example: Excel file, SAS file, CSV, etc.)

Type of presentation requested:

presentation

presentation

Target audience (grant, community group, clinicians, etc.):
Please specify.

Intended use:
Please specify.

Event date:

Requested date of completion:



*Please note, data requests may not be completed by requested due date if surveillance staff are given less than 2 weeks to complete the analyses. Staff will be in touch with you to negotiate/confirm a final date for product delivery and to clarify any questions.

Comments:


If you have the original grant request and/or an example of previously completed work after which you wish to have your product modeled, please state so in this area. You may be asked to email it.

 

For presentations, specify time allotted, number of people expected, and any specific focus areas you would like covered.

To prevent abuse of this form, please type
the following letters/numbers
GH4A7
into the field below. Thank you.
REQUIRED


Last Modified: 15-Aug-2016 11:31:10 am