Perelman School of Medicine | Office of Academic Affairs

Request for Faculty Data

You will have the option to download or save a pdf of this completed form.

Instructions

*Note: This form is intended for data reporting requests only and should not be used for individual record or system access requests. Please DO NOT submit access requests here.

Please answer each question.
Be as descriptive as possible in your request, including specific fields where applicable.
All requests for Personally Identifiable Information (PII) must include a clear business need. PII includes, but is not limited to, name, age, email addresses, personal mobile numbers. Please note that in some instances we may not be permitted to release PII data. If not, we will provide aggregate data.
All requests must comply with the University's Privacy Polices & Guidance. Requestors should familiarize themselves with the University's Data Access Standards and Principles of Responsible Conduct. Please review to understand what may be restricted data.
Please allow up to two weeks for processing standard reports. We will follow up directly with any questions.

Requester Full Name

First Name

Last Name

Requestor Email

Email Address

Requester Role

Staff
Faculty
Student
Other

Please enter your role and affiliation if not University staff, faculty or student

Requestor Primary Department Affiliation
If not affiliated with a PSOM academic or administrative department, select "Other" and specify in next question.

Name of your department, center, institute, or other University-affiliated group

Name of your PSOM administrative department