EP-002 Restricted Data User Request Form

Restricted-Data Use Request Form
Version 1: August 2021

Required Fields

Instructions for completing

Investigator First Name

Fill in the blank

Investigator Last Name

Fill in the blank

Investigator Contact email

Fill in the blank

Research Proposal

Copy/paste existing documentation (Word, PDF)
describing the need for the data and how it will
be used

Data Requested

Select from drop-down list of all data available
through MCC restricted-access VDEs.

Following submission of this information, the Investigator send the following documents via email to
[email protected] with subject line MCC VDE Data Request.
Signed Restricted Data Use Agreement

Email signed copy of the RDUA (Word, PDF)

Research Team CV/Resume/Biosketchs

Email existing documentation (Word, PDF). Must
include the CVs for each individual who will
access the restricted data under this agreement.

Institutional Review Board Approval or
Exemption documentation

Email existing documentation (Word, PDF) that
documents IRB approval of the Research Proposal
and Data requested.