UConn Institute for Sports Medicine Data Request Form: Prior to submitting your request for institutional data, ensure you have all required forms and information necessary. Please review the information available on the UConn ISM website for more information. The time to receive data depends on the complexity of the request and availability of our research personnel. Please give us as much advanced notice as possible if you are working with a deadline. UConn Department* Name* First Last Email* Phone Number*I am*FacultyStaffGraduate studentOtherFaculty advisor From which database are you requesting data?*Contact databaseClinical database (full)Clinical database (de-ID)Data request description*Please describe the type of data you are requesting. For example: Patients 18-25 who have sustained a primary ACL injury.Purpose of request*Internal reviewStudy recruitmentResearch projectOtherHow will the data being requested be used? Who is the intended audience?Please provide any additional information about the request:Please include the approved and stamped IRB-1 protocol document (if applicable) Drop files here or Select files Max. file size: 100 MB. You may also upload any other documents you feel would be helpful to complete the request.Date needed by: Month Day Year Please try to give us at least 2 weeks to complete your request - your data may be ready sooner depending on the complexity of the request and other priorities of our team.NameThis field is for validation purposes and should be left unchanged.