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Dear John Smith

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					                                                                                       Office of Development and Alumni Relations




            The University Client Relationship Management System (UCRMS) is subject to the Privacy Act 2000

Request for Alumni Information from the UCRMS
The UCRMS contains biographical details of UWA graduates, staff, supporters and friends of the University.
Conditions of Use of UCRMS Information
   All Information obtained from the UCRMS is strictly CONFIDENTIAL
   Do not distribute copies of UCRMS information supplied to third parties and should be deleted immediately after use
   UCRMS information is not to be used for any purpose other than that for which approval was granted
Inquiries
        UCRMS Help - Office of Development and Alumni Relations
        Phone: +61 8 6488 1723             Fax: +61 8 6488 1063
        E-mail: UCRMShelp@uwa.edu.au



APPLICANT DETAILS

Name            ___________________________________           Faculty / School / BU     _______________________________

Phone           ___________________________________           Email                     _______________________________

USER DECLARATION

I have read the conditions of access and agree to abide by them

Signature       ___________________________________           Date                      _______________________________

DEAN/HEAD OF SCHOOL (or delegate) DECLARATION

I acknowledge that this applicant has a legitimate need for the information requested.

Name            ___________________________________           Phone                     _______________________________

Signature       ___________________________________           Date                      _______________________________

DATABASE REQUEST (Please allow 5 business days for processing your request)

Description of Graduate Group (e.g. Bachelor of Arts 1995 in WA) _____________________________________________

_____________________________________________________________________________________________________

Purpose - Please Name the Fund/Project/Function &/or Dates linked to it (e.g. Medical graduates of 1978 reunion)

_____________________________________________________________________________________________________

_____________________________________________(Please attach copies of materials which will be sent to graduates)

Date required       ______________________________            Sort by                   _______________________________

OFFICE USE ONLY

Signature           ______________________________            Date                      _______________________________

Query Name          ______________________________________________________________________________________

Date completed      ______________________________            By                        _______________________________




                                                       Revised 14 July 2009

				
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