Data Request Form

What is your name? *

What organization are you affiliated with? *

Who is the primary contact at your organization for Health District staff to work with on this request (include name and email/phone number)? *

Please describe what data you need, your purpose for requesting the data, and what you intend to do with it. *

What deadlines do you have for receiving the data you've requested? *

Note that we will aim to process your request within two weeks. We will communicate with you if your request may require more than two weeks to process.

Are you requesting data for a specific funded project? If so, how is it funded? Funding can come from various sources including government grants, private foundations, and industry partners, among others. *

By typing your name here, you acknowledge that the data owner is the Health District of Northern Larimer County and you agree to cite the source as the Health District of Northern Larimer County in any publication or other public use of this data. *

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Data Request Form

December