Saint Louis University

Report Request Form

Requestor Information
Q1Date of Request (MM-DD-YYYY):
Q2Report Name:
Q3Date to be Completed (Please allow two weeks. MM-DD-YYYY):
Q4Person Making Request:
Q5E-mail Address:
Q6Contact Person (If different than above):
Q7Access Needed for (If different from person making request or contact person):
Q8Type of Request:
New Request
Modification of Existing Report
Q9Purpose/Description of Request (limited to 500 characters):
Q10Data Fields You Want Displayed on the Report (e.g. Last Name, First Name, Student Classification, Major, Instructor, Course, CRN, etc... (limited to 500 characters):
Q11Output Format:
Q12Sort Fields:
Q13Frequency of Use:
At Census
At End of Term
Q14Additional Information (Examples of reports can be submitted to our office via e-mail or campus mail. Limited to 250 characters):
The Family Education Rights and Privacy Act (FERPA) (the Buckley Amendment) protects the privacy of student records. The requestor agrees to maintain the confidentiality of the requisitions provided by using them exclusively for their intended purpose, by storing them in a secured area and by disposing of them in an approved manner (i.e. shredding). The requestor may be held liable for information divulged to unauthorized parties as a result of negligent maintenance or use of reports by the requestor or the requestor's agents.

Please press submit to complete this form. If you have any questions please contact Diane Barbeau at 977-2223 or
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