* 1. Name:

* 2. E-mail:

* 3. Department/Program:

* 4. Planning Wing Affiliation

* 5. Describe the proposed request. Please specify year(s), term(s), population(s) and metric(s).

* 6. Describe how the research will be used (i.e. how will this information facilitate the development of the report, project, etc.).

* 8. Please specify the deadline for your request (MM/DD/YYYY).

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