Broadcast Email Request Form by 0p4zWCl2


									                       ALUMNI-ONLY DATA REQUEST FORM

DATE OF REQUEST:           7/4/2012                       DATA NEEDED:            NOT “ASAP”
CHAPTER / UNIT:             Entity                        * Needs to be 10 business days after request date
CONTACT / DEPT:              Contact / department
E-MAIL / PHONE:               E-mail / phone

 Our privacy policy does not permit us to release e-mail address lists. To e-mail to an alumni list, please submit
 the Broadcast E-mail Request form. For data on donors or other groups, please use the UHF Data Request
 form. E-mail this form to and allow 10 business days for processing.

1. Please describe how the data will be used, and attach a sample of mailing (draft OK).1
       Event (include name and/or short description, and date):           Event info
       Mailing (include short description and mail date): Mailing info
       Other purpose (if not for an event or mailing, list specific purpose):         Other purpose

2. Which group of alumni do you want to INCLUDE in this data request? Include all that apply.

   Class year(s):
   ZIP code(s):

3. What information about these alumni should be included in your report? Please check all that apply.

      Name                                               Spouse name
      Preferred address (recommended)                    Chapter affiliation
      Home address                                       Membership type (single, join, life)
      Business address                                   Membership start & end dates
      Home phone                                         Degree info (year, school, campus)
                                                                                                        Rev. 07/2010
        Work phone                                              All of the above
4. Do you want multiple names in the same household combined into one record? Recommended for
   direct mail and calling.  Yes       No

5. UH Foundation Alumni Data Usage Affidavit:

     I (requestor's full name) agree to the Confidentiality & Information Systems Policy below, and I attest
     that the information I am requesting will only be used for the purpose(s) disclosed on this form.

     _____________________________________________                                  _____________
     Signature of authorized requestor                                              Date

Your report will be delivered in an Excel spreadsheet via secure server or ftp site – we cannot
e-mail the information to you because the data would not be secure. DO NOT e-mail the
information after you retrieve it – it puts our alumni’s identity information at risk. We can always
pull the information again. Should you need the same information again in the future, it is best to do a
new pull each time because our database is updated daily.

This confidential information has been entrusted to the University of Hawai’i Foundation to be used only
for purposes that directly relate to the mission of the University of Hawai’i. By passing the data to you,
we are passing responsibility to you to protect the information of our alumni and to use it only for
purposes UH alumni could reasonably expect. After using the data as described above, the data must
be destroyed in a manner that will prevent any third party from obtaining it. Our office can shred
materials for you if necessary. Because our database is constantly being updated, these reports are
time-sensitive and will not be accurate after the period for which you are requesting it.

If you have any questions about this policy or the data request process, please contact Roxanne Kam
at or (808) 956-0469.

1.   Event mailings: In order to help us to coordinate mailings and to respond to any alumni queries we may receive, we
     request that you provide us with a sample mailing piece or full details of your event (and contacts, if different from above).
     To help us with cross-chapter date coordination, please let us know your planned mailing and event dates. We can let you
     know if there are other UH or UHAA mailings or events around that time.

                                                                                                                     Rev. 07/2010

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