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Alumni and Donor Information Request Form
Alumni and Donor Information Request Form and Confidentiality Agreement
Email *
Understanding
University Advancement has been charged by the Chancellor of the University of Michigan-Flint to be the official custodian of all alumni/donor biographical records, addresses, mailing lists, and mailing labels. This information is maintained by the University of Michigan exclusively for alumni and development-related purposes.  The university makes alumni information available to authorized university representatives in support of approved related activities. It is the responsibility of the school, department, or unit having access to the information to maintain the confidentiality of that information. All information is covered by this confidentiality statement. Information is not available to groups or individuals within or outside the university for purposes including, but not limited to, vendor mailings, political mailings, unauthorized fundraising appeals or the creation of any lists that have not been approved, in writing, by University Advancement. University Advancement works in collaboration with the Office of University Development in Ann Arbor to fulfill approved requests. Please allow a minimum of two weeks for approved requests to be fulfilled.
Agreement
Submission by a university faculty or staff member certifies that:

1) Applicant is a faculty/staff member.
2) The data will be used only for the benefit of the University of Michigan.
3) The use of the data is a part of, or reasonably related to the university’s overall educational program and meets all the requirements and limitations described above and in the Standard Practice Guide.
4) The downloading and transfer of digital data will not be allowed. Printed data can be released to volunteers acting on behalf of the university with the written permission of the Vice Chancellor for University Advancement.

University Advancement has the right to approve or deny this application and to monitor the use of any released data. Violation of this agreement will terminate assistance with any current or future requests for alumni/donor information and may result in an employee suspension and/or termination.  
Contact Information
Applicant
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Title
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School/College/Department
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Campus Phone
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Campus Email
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Intended Use of the Information
I am using this information for
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Required
How do you plan to use this information?
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Required
Explain, in as much detail as possible, the intended use:
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Explain, in as much detail as possible, your target audience, including whatever parameters you would like to include when generating your list:
Intended Use Date
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Please allow a minimum of two weeks for approved requests to be fulfilled.
To ensure accuracy and comply with U-M's standards, the data we will provide to you is only valid for 10 days.
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DD
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Dean/Director Information
Have you spoken to the Dean and/or Director for approval to submit this data request?
Note: Approval from your Dean and/or Director is required for us to move forward.
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Dean's/Director's Name
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Dean's/Director's Email Address
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By pressing submit, you are agreeing to all of the terms and the confidentiality agreement.

In order to provide you with the best possible service, please notify us at least three weeks before you need the information. The Alumni Relations team looks forward to meeting with you after we review your information!
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