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2. Office of Reentry & Justice - Data Request Form

   To submit your data request, please fill out this request form to the best of your ability while noting that certain fields will be required. Information requested within this form include but are not limited to: 
    

   • Requestors contact information 
   • Purpose of the data request: (i.e., What questions are you trying to answer? Why is this data needed? How will this data be used?)
   • Date parameters:  time frame of data requested: (i.e., fiscal year 2011/12; calendar year Dec 1st – 31^st; or a single day snapshot)
   • Data population: Adult, juvenile, or special populations (e.g., AB 109)
   • Specific data fields requested: (i.e., Demographic characteristics such as age range, gender, race/ethnicity, county region, etc.)
   • Date data is needed by: (i.e. Is this a one-time request or recurring? If recurring, how often?)
   • Final format of the data:  Excel, Word, pdf

   It is imperative that your request and stated purpose is as specific and detailed as possible. Lack of or limited background information regarding the purpose of your request may result in a delay in processing.

   All personal identifiable data (e.g., client names, addresses, date of birth) is confidential and WILL NOT be distributed to unauthorized requestors.  Further, any aggregate data summary of less than 10 data points that may present a potential breach of confidentiality will not be distributed.    

4. Contact Information
6. First Name*
7. Last Name*
9. Address1
11. Address2
13. City*
14. State*
15. Zip*
17. Job Title*
18. Organization/Department*
20. Phone Number*
21. Email*
23. Name of Supervisor*
24. Supervisor Title*
26. Supervisor Email *
28. Supervisor Phone#*
32. Research Project Information

    The following information provides ORJ with an overview of the project for which the requested data and information will be used. 

34. Request on Behalf of?*

    Please check all that apply. 

    *If you selected "Other" or "Program/Initiative", please specify the name of the program/initiative or entity you are requesting data for in the "Other" comment box.

    1. Self
    2. Research Institution/Group
    3. State/County/Municipal Agency
    4. Media
    5. Elected Official/Staff Representative

    1. University (Student)
    2. University (Researcher)
    3. Non-Profit/NGO
    4. Program/Initiative*
    5. Other*
36. Other:
38. Purpose of the Project*

    Please describe the project (e.g. dissertation, research study, article, grant proposal etc.) this data will be used for; how the data will contribute to the project (i.e. what research question(s) will the requested information assist in answering); and who the intended audience of the project will be. 

    
    

    Please be as detailed as possible. Lack of or limited background information here may subject your request to delays in processing.

40. Data Request Information*

    Please describe in detail the data you are requesting.

42. Applicable Data Definitions*

    Please provide any relevant data definitions (e.g. recidivism, violations, etc.) necessary in fulfilling this request. If none, please type N/A.  

44. Frequency of Report*

    How often do you need this report? Requests with a frequency of "One-Time" will be assessed and approved on a case-by-case basis.

46. Desired Completion Date*

    When do you need this by? While we will try to work within your timeframe, we cannot guarantee a final completion date.

47. Final Data Report - Format Type*

    Please select the type of format you would like to receive the final data report. Check all that apply.

    1. Word doc
    2. Excel Spreadsheet
    3. CSV file
    4. PDF file
    5. Other* (please specify)
48. Other:
52. Population & Demographic Information

    The following information will detail the scope of population-related data being requested. 

54. Justice-System Population Type*

    Please select all that apply. 

    1. Adults
    2. Youth/Juveniles
    3. Young Adults/Transition Age Youth (TAY)
    4. Special Populations* (please specify)
55. Gender*

    Please select all that apply. 

    1. Female
    2. Male
    3. Other* (please specify)
57. Other:
58. Other:
60. Age Range*

    Please specify the desired breakdown of age range(s), if applicable. 

61. Race/Ethnicity*

    Please specify the desired breakdown of racial/ethnic group(s), if applicable.

63. Geographic Location(s)*

    Please specify the desired geographic locations (e.g. countywide; regions), if applicable. 

64. Specific Cities*

    Please specify the desired cities to be included. NOTE: City-level data can be limited and may not be available in all cases.

66. Date Parameters *

    Please provide the date range or timeframe of the requested data.

67. Additional Notes

    Please provide any additional information that will assist us in developing this report.

Leave This Blank:


69. 1. Receive an email copy of this form.
70. Email address

    This field is not part of the form submission.

71. Submit

* indicates a required field